General Sports Medicine
Previously, we have discussed the use of topical nitroglycerin, needle tenotomy, and dextrose prolotherapy for refractory tendinopathies. In this post, we will review the rationale and literature behind Extracorporeal Shock Wave Therapy (SWT).
There is much debate regarding screening for cardiac disease in our athletic population. Prevalence of inherited cardiac disease is estimated at 3% in the general population
Hyperthermia is defined as the elevation of core body temperature above the normal diurnal range of 36 to 37.5ºC, due to failure of thermoregulation. Hyperthermia is different from the more common sign of fever, which is induced by cytokine activation during inflammation and regulated at the level of the hypothalamus. It is important for the clinician to review additional differential diagnoses as outlined in Table 1 below.
In just a couple of weeks, many sports medicine physicians will head to the sideline for high school football. Although a low incident of catastrophic injuries occur in sports, an emergency action plan (EAP) can be the difference between life and death in the athlete
Osteoporosis is a disease that is the most common bone disease in humans and is characterized by low bone mass and skeletal fragility, which results in an increased risk of fracture. Annually, two million fractures are attributed to osteoporosis, causing more than 432,000 hospital admissions, almost 2.5 million medical office visits, and about 180,000 nursing home admissions in the USA
So you are either primarily taking the CAQ-SM or recertifying? Well this post is for you.
Some may argue that the art of the physical exam is dying. That is not true with musculoskeletal based specialties where the physical exam is critical. One of the key components of the musculoskeletal exam are the special tests. It is easy to get lost in the weeds and sports medicine providers can often be buried under the mountain of available special tests.
The field of Orthopaedics has been a historically male dominated specialty. Amongst all surgical specialties, Orthopaedic surgery ranks at the bottom of the list when looking at the percentage of female residents in a given specialty. There are multiple theories as to why females do not end up in Orthopaedics. These range from lack of exposure to the field early in training and a lack of female mentors.
Sports medicine physicians have to be ready for anything whether they are covering a game, a mass participation event such as a marathon, or multi-sport events. They may even be providing EMS-like coverage for attendees of a game or concert.
Congratulations, you finally got the email to schedule your first fellowship interview. What happens next? The interview process is fairly simple and is similar to when you interviewed for residency. The first step involves scheduling the interview. …
The ACL, or anterior cruciate ligament, extends from the lateral femoral condyle to the anterior medial aspect of the tibia. The bands of the ACL act as a biomechanical restraint for rotation and limits anterior translation of the tibia on the femur. It assists with knee stability during running, jumping, cutting or pivoting.
Patellar chondromalacia represents a degenerative process of the hyaline cartilage coating the posterior patella as it articulates with hyaline cartilage of the femoral groove. It is often termed patellofemoral pain syndrome (PFP) or runner's knee. The term patellofemoral pain syndrome generally refers to anterior knee pain and is more of a “catch all” term that is not specific to chondromalacia, however the terms are frequently used interchangeably.
Shoulder disorders or complaints are very common in a sports medicine practice. An unusual cause that can require a high index of suspicion is thoracic outlet syndrome.
This article reviews 6 of the more common causes of shoulder pain; rotator cuff tendinitis, adhesive capsulitis, osteoarthritis, bursitis, acromioclavicular joint disorder and clavicular disorders including osteolysis and fractures.
The stages of throwing in an overhead athlete are well known and have been studied exhaustively. Despite all of the studies on throwing motion, up to 30% of youth baseball players have shoulder or elbow injuries and 73-79% of these injuries are due to pitching.
Patients with a history of shoulder dislocations are frequently seen in sports medicine clinics. The term ‘glenohumeral instability’ encompasses a large spectrum of disease from joint subluxation to a complete dislocation
This article will cover some of the randomized controlled trials behind shoulder injections including adhesive capsulitis, subacromial impingement and biceps tendonitis. Injections with depot corticosteroids are used by many to provide both therapeutic and diagnostic value. They can also serve to delay or possibly avoid the need for surgery in some situations.
Hand and Wrist
Scaphoid fractures are the most commonly fractured carpal bone, accounting for 2-3% of all fractures and ~10% of all hand fractures (Duckworth, 2012). They account for approximately 60% of all carpal fractures (Hove, 1999).
With the increasing popularity of cell phone use, there is a corresponding increase in thumb-related pathology. Osteoarthritis represents one such overuse syndrome. The second most common location in the hand where patients develop osteoarthritis is their thumb trapeziometacarpal joint (Glyka Martou, 2004). Unfortunately for those suffering, the CMC joint is involved with flexion, extension, adduction, abduction, and opposition of the thumb (David Melville, 2015).
Wrist injuries are a common part of an orthopedic practice. Patients frequently present for evaluation after a slip and fall injury and the development of acute wrist pain. Radiographs are part of the initial evaluation for all acute wrist injuries. When interpreting wrist x-rays, radiologists will discuss multiple different angles and measurements that correlate with various clinical conditions.
Intersection syndrome is an uncommon overuse injury of the forearm. It is termed ‘intersection’ due the pathologic relationship at the intersection of the 1st dorsal compartment (containing the abductor pollicis longus [APL] and extensor pollicis brevis [EPB]) and the 2nd dorsal compartment (containing the ECRL, ECRB).
Metacarpal fractures are a commonly encountered orthopedic injury. Metacarpal fractures can occur at the head, neck, shaft, or base of the metacarpal.
This article will cover some of the randomized trials and reviews on corticosteroid injections for some of the most common issues that present to a sports medicine practice including lateral and medial epicondylitis, de Quervain’s tenosynovitis, trigger finger, carpal tunnel syndrome.
Lateral epicondylitis is one of the most commonly treated conditions in a primary care sports medicine clinic. Patient’s typically complain of lateral elbow pain that is worse with activity. Certain activities like holding a jug of milk or turning over their hand are likely to worsen the pain. Fortunately, we have multiple treatment modalities to offer them.
Patients who have lateral hip pain are frequently told that they have greater trochanteric bursitis. However, correct nomenclature now refers to the condition as greater trochanteric pain syndrome (GTPS) (Paul Barratt, 2017)
The purpose of this review is to discuss the epidemiology, risk factors, diagnosis as well as management of hamstring injuries. We will also discuss the rehabilitation protocols and indication for surgical referral. These injuries are notoriously challenging and associated with significant missed playing time.
Femoroacetabular impingement (FAI) has become an increasingly recognized cause of hip pain, especially in young active adults (Ganz, 2003) Accordingly, the body of knowledge surrounding the understanding and management of FAI has grown substantially (Tucker, 2015). It is imperative for sports medicine clinicians to understand current principles and best practices regarding the pathophysiology, diagnosis, and treatment of FAI.
Next in the series, we will continue to discuss the evidence related to corticosteroid injections by moving distally to the hips and knees. As with others, we will cover randomized controlled trials and systematic reviews on corticosteroid injections for issues common to orthopedics such as trochanteric bursitis, hip osteoarthritis and knee osteoarthritis.
Foot and Ankle
We will cover randomized controlled trials and systematic reviews on corticosteroid injections for issues common to orthopedics such as ankle osteoarthritis, plantar fasciitis and Morton’s neuroma.
In part 4, we will review medications and supplements that can help or have been investigated to help with recovery.
In part 3 of the our review of recovery modalities, we will cover acupuncture, ultrasound, electrical stimulation, laser therapy and hyperbaric oxygen.
In this post, we will review the literature that evaluates the effects of compression garments, heat and cold on recovery.
Physical activity, weight training, and sports are associated with a wide variety of post-exercise sequelae including muscle fatigue, delayed onset muscle soreness, discomfort, pain, and soreness. In part 1 of this series, we’ll review the current evidence for massage therapy, foam rolling and stretching, and to see which, if any, have beneficial effects on recovery for the athlete.
Mr. Smith is a 65-year-old man who presents to our office with lateral elbow pain. After performing a physical exam you diagnose him with lateral epicondylosis. He has had no relief from 6 weeks of physical therapy and would like to know what else he can try.
After covering introduction, imaging and treatment strategies of persistent post-concussive symptoms (PPCS), also termed post-concussion syndrome, we continue by examining the evidence behind commonly used pharmacologic agents
After covering introduction and imaging of persistent post-concussive symptoms (PPCS), also termed post-concussion syndrome, we continue moving forward to examine treatment strategies. The recommendations have been evolving over time and treatment for both acute and persistent concussive symptoms and has changed substantially from original strategies.
The outpatient management for individuals with persistent post-concussive symptoms is variable and can be frustrating for both patients, parents and providers.
The definition of post-concussion syndrome (PCS) is somewhat controversial and there is disagreement among sports medicine physicians regarding the diagnosis.
Sports and recreation-related concussions (SRRC), a form of mild traumatic brain injury (mTBI), are a very common and heavily publicized injury in sports medicine. Unfortunately, in rare cases, athletes may present with concussion-like symptoms but have the more dreaded moderate traumatic brain injury.
Ketorolac Tromethamine, often referred by its trade name toradol, is an injectable non-steroidal anti-inflammatory drug (NSAID). A growing utilization among orthopedists and sports medicine physicians is to use it for intra-articular analgesia and anti-inflammatory. Although generally not well studied, this article seeks to review the evidence of that indication.
The focus of this review is on dextrose prolotherapy and the evidence behind it’s utilization.
ports medicine physicians should be cognizant of potential complications, especially nephrotoxicity. Acute kidney injury (AKI) is a major cause of morbidity and mortality. In individuals admitted to the hospital with AKI requiring emergent dialysis, mortality rates can exceed 50%. Awareness can lead to better prescribing practices and increased safety for at-risk patients.
Many orthopedic practices in the United States will perform injections in 3-month intervals or more spaced out if possible. The main reasoning behind the limitation of injections is preservation of cartilage and avoidance of side effects. There is contrasting evidence regarding repeated corticosteroid joint injections and cartilage damage.
In 2013, NSAIDs had accounted for more than 70 million prescriptions and 30 billion over-the-counter purchases. Sports medicine physicians should be cognizant of potential complications, especially gastrointestinal toxicity. Awareness can lead to better prescribing practices and increased safety for at-risk patients.
Corticosteroids are medications that are commonly injected and many people refer to these injections as “cortisone” injections. The first corticosteroid injection was performed in 1953 and the first clinical trial was performed in 1958 1,8. The medications are synthetically formulated to mimic the steroid hormone cortisone, which is produced by the adrenal gland and released in response to stress
Non-Steroidal Antiinflammatory Drugs (NSAIDS) are the most commonly used drugs in the US according to the CDC. NSAIDS address a wide range of maladies including pain, fever and inflammation. For this reason, they are commonly used by sports medicine physicians to treat orthopedic injuries and pain.
Due to the large area of distribution of the tibial nerve and its branches, there are many locations where the nerve can become entrapped. As a result, entrapment neuropathy can cause a wide constellation of symptoms.
August 2019 Sports Medicine Journal Roundup
Lumify was launched in 2015 and was one of the most versatile ultrasounds when it was introduced.
The handheld market for ultrasound continues to grow as more physicians discover the field known as POCUS (point of care ultrasound). One device on the market is the Butterfly iQ.
July 2019 Sports Medicine Journal Roundup
June 2019 Primary Care Sports Medicine Journal Roundup
May 2019 Primary Care Sports Medicine Journal Roundup
April 2019 Primary Care Sports Medicine Journal Roundup
March 2019 Primary Care Sports Medicine Journal Roundup
February 2019 Primary Care Sports Medicine Journal Roundup
January 2019 Primary Care Sports Medicine Journal Roundup
December 2018 Primary Care Sports Medicine Journal Roundup
November 2018 Primary Care Sports Medicine Journal Roundup
October 2018 Primary Care Sports Medicine Journal Roundup
September 2018 Primary Care Sports Medicine Journal Roundup
August 2018 Primary Care Sports Medicine Journal Roundup
July 2018 - Primary Care Sports Medicine Journal Roundup