Search for tag: "ortho injury clinic"
Most children—especially child athletes—will complain of heel pain at some point in their development. This may be an inflammatory condition called Sever’s Disease. Dr. Cindy…
July 12th, 2021
Many kids, especially athletes, will complain that their feet hurt at some time. Heel pain is especially common and especially during growth spurts.
Heel pain in athletes who are growing actually has a name. It's called calcaneal apophysitis, otherwise known as Sever's disease. It is most common between the ages of 9 and 14 and is seen in athletes who do a lot of running and jumping. My teenage soccer player has this and actually so do several of his teammates, or the teammates of my younger son who will probably end up having this also. Basically, what it is, is inflammation of the growth plate of the heel bone. The bones, muscles, and tendons in that area all grow at different rates during puberty. And when they're out of sync, the muscles and tendons pull too hard on the growth plate and that causes the inflammation.
So what can your child do to help once the pain has started? Well, to be honest, the pain will improve most once your child is done with their growth spurt. Also, it's best to stop any activities that cause pain. But, of course, we know that's not going to happen, especially if your child is on a competitive or a school athletic team.
So other things that help include having an ice pack in a towel and icing the heel for 15 minutes every one to two hours during flare-ups. Have your child take an anti-inflammatory pain medicine, like ibuprofen or naproxen. But be sure to check with your child's pediatrician on dosing. Gel heel cups and shoes with good support are also helpful. They help put less pressure and less stress on the heel. Your child's pediatrician can also give you exercises that can help with stretching and which can help with the pain and help keep the condition from getting too bad.
If the pain continues, your child may be referred to a physical therapist. And if all else fails, then your child will be put into a walking boot and referred to an orthopedic specialist for management of severe cases. Eventually, Sever's disease gets better, but not really until your child has stopped growing and that growth plate closes. Until then, manage the pain and follow the advice your child's doctor gives them.
Most children—especially child athletes—will complain of heel pain at some point in their development. This may be an inflammatory condition called Sever’s Disease. Learn how you can help relieve your kid's foot pain.
An elbow injury used to mean a lost season for baseball pitchers. Ulnar collateral ligament (UCL) replacement - or the Tommy John Surgery - can take up to 18 months before a return to the pitch.…
May 5th, 2021
Interviewer: Yeah. So, if you have some elbow pain while you're pitching, there is something you can do about it and actually something you should do about it. And there's a new procedure that might be the thing that you need.
Dr. Peter Chalmers is an orthopedic surgeon. He's an elbow specialist. He's also the current team physician for University of Utah baseball and Salt Lake City Bees Triple-A baseball. So if somebody does have elbow pain while they're pitching, where do you start with that diagnosis, Dr. Chalmers?
Dr. Chalmers: Yeah. Absolutely. So elbow pain during pitching, it's not normal to have really, really a sore elbow with pitching. And there can be a couple of different causes, and some of them can be problematic for the future for a pitcher. So, definitely, I think it's worth, after a period of rest, if the pain doesn't go away, seeing someone to be fully evaluated with, you know, having someone take a look at the elbow, and then potentially getting an MRI to take a look at the cartilage and the ligaments within the elbow.
Interviewer: All right. And if the condition happens to be something called an ulnar collateral ligament injury, then there's a procedure that's been used for a long time called Tommy John surgery. Tell me a little bit about that, and then we're going to talk about the alternative, which could be better for some patients.
Dr. Chalmers: Yeah. Absolutely. So, for a long period of time, if you tore your ulnar collateral ligament, the ligament on the inside of the elbow that basically holds the upper arm and the lower bones together when you pitch a baseball, if you don't have that ligament, those bones try and fall apart, and it's basically not possible to pitch a baseball. If you tore that ligament, historically, then your career was just over.
And there was a pitcher named Tommy John, who had that injury, and he went to a surgeon who said, "Well, there's got to be something we can do," and they invented this procedure to reconstruct or rebuild the ligament using a tendon graft. And that actually works pretty well, but it has a very long recovery. It takes about a year to get back to play because the new tendon has to become a ligament over the top of the old ligament. And that process is very slow.
So that was the historic way that we would treat ulnar collateral ligament injuries, and the pitcher that first underwent it, his name was Tommy John. So they're commonly referred to as the Tommy John ligament or Tommy John surgery.
Interviewer: And now there's a new procedure. So I've heard that considered called reconstruction, and now there's a new procedure that actually just repairs the ligament and has some better outcomes. So tell me a little bit about that.
Dr. Chalmers: The good thing about many of these ligament tears is often the ligament is torn right off of either the upper arm bone or lower arm bone side. And the ligament itself is still good quality tissue. So, historically, we would replace that whole ligament with a new tendon graft.
The new procedure is to repair the patient's own ligament and allow their own ligament to serve as their ligament going forward. That has a much quicker recovery and can get pitchers back to play in six months. So that's been a huge advance in our treatment for this injury and has certainly, for a lot of our players, granted them ability to get back to another season or even sometimes to get two seasons in depending on the timing.
Interviewer: So, when you're working with a pitcher, how do you determine which one of these two that you're going to use?
Dr. Chalmers: So there's a number of factors that go into that. Certainly, the appearance of the ligament on the MRI and the location of the tear play a role, but often during surgery, we'll also assess the quality of the tissue. And if the tissue is robust enough, then we can use the patient's own tissue to do the repair.
Interviewer: If it is an option, then is it just as good as the Tommy John surgery? You said, definitely, you could get back to playing faster. Is it as a robust of a repair?
Dr. Chalmers: It may be better.
Dr. Chalmers: Some of our early data suggests that the rates of return to play may be higher after repair than they are after reconstruction.
Interviewer: And I understand another advantage of the ligament repair is if you have a younger athlete, that this would be an option where Tommy John surgery would not be an option. Tell me about that.
Dr. Chalmers: Yeah. Definitely, younger athletes have the highest capacity for healing. And so, in a younger athlete, this surgery can work very, very well, and that's who it's been performed in mostly to date. But in someone who's really young, if they have open growth plates, you may be concerned about performing a surgery with a ligament graft, where we may have to drill tunnels in the bone that may disrupt the growth in the future. So this is a nice option for that patient population.
Interviewer: And what does the recovery look like then? You said that the recovery is faster. You know, Tommy John surgery could take up to a year. How fast is this recovery, and what's the rehabilitation process like?
Dr. Chalmers: So as early as two weeks out from surgery, the patient begins moving their elbow. About a month from surgery, they begin strengthening. And the whole goal here is that you have to start strengthening early because as early as three months out from surgery, the pitchers will start throwing again.
Dr. Chalmers: And the goal then is to get back to full play with full velocity, pitching full games by six months.
Interviewer: That sounds pretty amazing. Is that pretty amazing from your perspective as an orthopedic surgeon?
Dr. Chalmers: It's a huge advance. It's a huge change over the year, sometimes 18-month recovery we saw historically with reconstruction surgery.
Interviewer: Are there downsides to this type of repair?
Dr. Chalmers: Well, it's a relatively new option, and so we don't have 5 or 10-year outcomes with it so far. But so far, it appears to have few downsides as compared to the reconstruction. There had been some concern that if you do this surgery, it may make another surgery in the future more difficult. And so far, those have not appeared to be true, but there have been very few of those performed because it works so well.
Interviewer: And it sounds like this is a very specialized procedure still at this point. What advice would you have for somebody choosing an orthopedic surgeon to do this type of procedure?
Dr. Chalmers: Well, I think that one of the most important things patients need to understand is that surgery itself is a technical skill, and it's important to find a surgeon that you feel like performs enough of those procedures to feel competent at it. So, as a result, I think when you look for a procedure that's less common like this, you need to find a surgeon that feels comfortable and performs enough of them, that they'll have already worked through the kinks and make sure that they're not going to have any problems performing this procedure for you.
That's one of the benefits of coming to a place like the University of Utah, where you have specialists in a large variety of areas. It allows each of us doctors to find a smaller niche and then, as a result, to be better at what we do.
Interviewer: I want to talk a little bit about this procedure. So what is, in your mind, the youngest patient that you would do this type of a procedure on?
Dr. Chalmers: One of the things that is unique about this area of the elbow is that right above the ligament is a growth plate. So for people who are skeletally immature, it's very rare to have the ligament be injured. And the vast majority of those that are skeletally immature, the growth plate itself sees most of the injury, if there is an injury. As a result, we very rarely perform this procedure for anyone under the age of 14 really.
Interviewer: Is there anything else about this procedure that you feel that a patient or a patient's parents would be interested in hearing that I missed?
Dr. Chalmers: One of the things that I think is really interesting about this procedure and really important for people to understand is that we've talked historically about the reconstruction and the tissue within the reconstruction as though we can make you a new ligament. But I will tell you that the tissue that we bring in from somewhere else is not the same as what you were born with. It doesn't have the same nerve fibers. It doesn't have the same pressure fibers.
And we demonstrated that actually pretty elegantly recently in a study we did with the Angels, where we looked at the changes in reconstructed ligaments as compared to non-reconstructed ligaments over the course of a single season or off-season on ultrasound, and found actually that the ligaments that had undergone a prior reconstruction respond differently to stress than native ligaments. And I think that's probably because they don't have all of their normal sensors within them.
So one of the big benefits of this procedure is that it preserves all that. It preserves all the normal pressure sensors and nerve fibers within your own ligament and allows it to respond normally to stress in the future. So that's a real benefit of this procedure over the reconstruction, and one reason why I think we're probably going to head more and more in this direction in probably a lot of areas of our field in the future.
An elbow injury used to mean a lost season for baseball pitchers. Ulnar collateral ligament (UCL) replacement - or the Tommy John Surgery - can take up to 18 month before a return to the pitch. Orthopaedic surgeon Dr. Peter Chalmers, explains how the recently developed UCL repair procedure could help injured baseball players get back to full throwing speed in just six months.
When kids are playing outside or competing on sports teams, injuries are a common occurrence. Ankle sprains in particular go hand-in-hand with the start of football and soccer seasons. Dr. Cindy…
August 24th, 2015
Dr. Gellner: It's time for back to school and sports and that means it's time for ankle sprains. How to help with this frequent sports injury is today's topic on The Scope. I'm Dr. Cindy Gellner.
Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kid Zone with Dr. Cindy Gellner on The Scope.What Is a Sprained Ankle?
Dr. Gellner: We're seeing a lot of kids that are going to back to school training camps for football, soccer, all sorts of sports that can twist up the ankle really quickly. So what exactly is an ankle sprain? Well, it's an injury that causes a stretch or tear in one or more ligaments in the ankle joint. Ligaments are strong bands of tissue that connect bones to the joint. There are many ligaments in an ankle.
The most common type of sprain involves the ligaments on the outside part of the ankle. That's the lateral ankle sprain. Ligaments on the inside of the ankle may also be injured, those are medial ankle sprains, as well as ligaments that are high and in the middle of the ankle, those are called high ankle sprains. Again, a sprain is caused by twisting your ankle. Your foot usually turns in or underneath you as you're walking, running, jumping, but it may also turn to the outside as well.
Sprains can be mild, moderate, or severe, but they all hurt. Symptoms of a sprained ankle include anything from mild aching to sudden pain, swelling, and bruising, which may look quite severe. You may have pain in the ankle even when you are not putting any weight on it.Sprained Ankle Symptoms
To diagnose a sprained ankle, your child's pediatrician will ask about your child's symptoms and how the injury occurred. So it's very important you know what happened at the time of the injury. That's very important to the pediatrician. They'll also examine your child's ankle and if needed, X-rays may be taken depending on the severity of the symptoms.Treatments for a Sprained Ankle
Treating a sprained ankle depends on how bad the sprain is. It can be remembered as the letters RICE, rest, ice, compression, and elevation. When your child first sprains their ankle, have them rest. Then, put an ice pack or package of frozen vegetables wrapped in a cloth on the area every three to four hours, for up to 20 minutes at a time. Raise the ankle with a pillow when sitting or lying down. And for compression, you can use an elastic bandage or even a brace that you can buy at your local store. Finally, keep your ankle elevated as much as you can for the first 72 hours.
If the sprain is severe, your child may need to use crutches until they can walk without pain. For the pain, your child can take an anti-inflammatory such as Ibuprofen or Naproxen, which is Aleve. Unless recommended by your pediatrician, do not take this pain medication for more than 10 days. Rarely, severe ankle sprains with complete tearing of the ligaments will need surgery. Your pediatrician will refer your child to an orthopedic doctor if that's the case. After surgery, your ankle will be in a cast for four to eight weeks.Sprained Ankle Recovery Time
Recovery time depends on many factors such as how old your child is, what kind of health they're in, if they've ever had a previous ankle injury, and the severity of the sprain. A mild ankle sprain may recover within a few weeks whereas the severe sprain may take six weeks or longer to recover even if it doesn't require surgery. Recovery also depends on which ligaments were torn. The lateral sprain, remember those outside ligaments, takes less time to recover than a medial sprain, the inside ligaments, or a high ankle sprain, the high middle ligaments.
We often get asked, "When can my child go back to playing sports?" Well, everyone recovers from an injury at different rates. Your child can return to the activities depending on how soon the ankle recovers, not by how many days or how many weeks it's been since the injury occurred. In general, the longer your child has symptoms before he starts getting treatment, the longer it will take to get better.
The goal is to return to his normal activities as soon and safely as possible. If your child returns too soon, they may worsen their injury. Your child may safely return to normal activities when they have a full range of motion in the injured ankle compared to the uninjured ankle. Also, they need to have full strength in the injured ankle compared to the not injured ankle and they need to be able to walk straight ahead without pain or limping.How to Prevent Ankle Sprains
For kids who are very active in sports, it's really important to try to remember how to prevent ankle sprains from happening in the first place. Be sure to have your child wear proper, well-fitting shoes, stretch before and after sports, avoid sharp turns and quick changes in direction, and consider taping their ankles or wearing an ankle brace during strenuous sports, especially if they've had a previous injury. If your child is a very athletic child, I can guarantee you they're going to have an ankle sprain. The most important thing is to address it right away, not wait, and let them recover before they get back out on the field.
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If your child plays outdoor sports, it's important to make sure their body doesn't get too warm. Emergency room physician Dr. Troy Madsen talks about the difference between heat exhaustion…
August 6th, 2021
Interviewer: It seems like unfortunately every year you hear a story about a student athlete, a young athlete getting heat stroke, getting really sick or dying at times. As a parent of, perhaps, a young athlete that's in a summer program or football training camp for the fall, even in August. What should you look for and what should you know, what would you want that person to know?
Dr. Madsen: That's a great question, you know kids in the summer, as you mentioned, are in a lot of sports camps and if you're a kid in a sports camp, the number one thing you want to do is impress the coach. That's what you're trying to do, you know. So you're getting out there and even if you're feeling lightheaded, you're still pushing yourself, you want to look like you're working hard and that's where kids really run into problems, and I think that's where you can really see some issues with heat stroke and heat exhaustion, are kids who are really trying hard, it's 100 degrees outside, they're playing football, they're in pads, whatever the situation is.
So the number one thing to watch for is let our kids know if they're feeling lightheaded, if they're feeling dizzy, to sit down and take a break because those are the first symptoms of heat exhaustion, as they start to feel nauseated, lightheaded. If they get to a point where they feel like they're passing out, if they look to you like they're just not responding well, that's when it becomes really serious and we get really concerned.
Interviewer: And hopefully a coach recognizes that as well and is not going, Madsen, man up.
Dr. Madsen: Exactly. Hopefully coaches are aware of it, but you've got to figure too, these coaches have 30, 40, 50 kids out there. They can't watch every one and know exactly what they're feeling so, yeah, hopefully they're aware, but definitely the kids, they need to let the coach know when they're just not feeling quite right.
Interviewer: Is there anything that would tell me that maybe my kid might be more or less susceptible to heat exhaustion, or heat stroke as somebody else, I mean, does it vary person to person?
Dr. Madsen: There's definitely some variability's. Certainly if you've got a little more weight, if you're a little heavier, that's going to increase your risk of heat exhaustion or heat stroke. If you've had problems in the past, that's something to be aware of as well. Obviously, depending on the type of sport the child is participating in and if they're wearing a lot of pads, exercising a lot, doing a lot of sprints, things like that where they're getting their body temperature up, those are situations where you need to keep a close eye on them as well.
Interviewer: All right, what do I do if I suspect heat exhaustion, maybe we should even say, what's the difference between heat exhaustion and heat stroke, and what should I do then?
Dr. Madsen: Yeah, so that's a great question. So that question often comes up, what is heat exhaustion mean, what is heat stroke? So heat exhaustion is when your body temperature gets up, I think we've all experienced that, you're lightheaded, a little big nauseated, just not feeling quite right. Heat stroke is when it gets dangerous, we're talking body temperatures of about 105 degrees and in that situation we're often times seeing people pass out, they're unresponsive. That's when they're at risk for organ failure and that's when it gets very serious, so once it gets to that point, just even the lightheadedness, dizziness, get in the shade, try and cool down, drink some water, try and get that person cooled down with a fan, something to try and get the body temperature down.
Interviewer: Pour water on their head, is that fine?
Dr. Madsen: Sure, absolutely. Pour water on their head, you know one thing you can do to really get the body temperature down quickly is with ice packs. Don't put ice directly on the skin but if you've got it in some sort of a pack you can put it in the arm pits, there's a lot of blood flow through there so you can get the body temperature to cool down fairly quickly, and if it's really serious where they're just not responding to you, if they're very confused, in that situation I'd get them to the hospital. Call 9-1-1 and make sure you get help for them.
Interviewer: It's nothing to mess around with at that point.
Dr. Madsen: Exactly. Once they're not responding or they're just not very responsive to you then it's much more serious.
Interviewer: Should you err on the side of caution if you have a question?
Dr. Madsen: Absolutely, err on the side of caution, you can always call the EMTs there, they can take a look, they may even check their body temperature, see how they're looking and maybe say, hey, he's okay, probably doesn't need to go to the hospital, but certainly, especially in sports camps, err on the side of caution.
The difference between heat exhaustion verses heat stroke. Learn what heat stroke is, what it does, the symptoms, and what to do if your young athlete appears to have it.