The new, 33-page guide provides comprehensive, easy-to-understand descriptions of common sports injuries, from ankle sprains and concussions, to cardiac arrest and heat stroke.
“AOSSM and AAOS have worked to create a guide unbiased information about sports injuries and treatments for athletes of all ages and skill levels
I came across a great review of Rotator Cuff Problems
Whether you’ve been relatively inactive or fairly athletic, age is the enemy of one of the most important sets of muscles in the body: the group of four known as the rotator cuff that surround the ball of the shoulder joint.
About 54% of adults older than 60 have a completely or partially torn rotator cuff, compared with just 4% of those between 40 and 60. But tears are most frequently caused by degeneration of the tendon due to age, rather than injury from sports or trauma. Studies show that tears can be managed without surgery in half of patients, mainly through physical therapy, pain medications, and avoiding activities that cause pain.
But one’s strength tends not to improve without surgery to reattach tendons to the ball of the shoulder joint. So, the question for many patients who want to have full use of their shoulder is less whether to have surgery than when and how. In a recent review in the Annals of Internal Medicine, researchers noted that patients and doctors struggle with when to stop nonoperative treatment in favor of surgery, but that repairing a tear earlier rather than later may result in better patient outcomes, earlier return to work and lower costs.
The Price of Delay
“Many patients who have a tear figure they can take six months and live with it, but left alone the tear will progress and you can get to the point where it is irreparable,” says David Altchek, a surgeon at New York’s Hospital for Special Surgery. Dr. Altchek says repairing torn rotator cuffs earlier with a new technique that uses a double row of sutures to fix tendons to bone, rather than a single row, is improving healing rates in his studies.
While some tears may never worsen or need surgery, says Ken Yamaguchi, an orthopedic surgeon at the Washington University School of Medicine in St. Louis, “the older somebody is when they get a repair, the less likely it is for the repair to heal.”
The good news is that surgery results in reduced pain and improved function in 80% to 95% of patients. And open surgery with big incisions is being replaced by new, less-invasive techniques known as mini-open and arthroscopic repair, which involve less pain and blood loss, shorter hospital stays and a generally easier rehabilitation period, according to the American Academy of Orthopedic Surgeons.
Ask Your Doctor
The academy, which recently updated its guidelines for rotator-cuff repair, doesn’t recommend for or against a specific technique for surgery. Dr. Yamaguchi, vice chairman of a working group that developed the guidelines, says there isn’t enough high-quality evidence to recommend any specific technique, a conclusion also reached by the Annals of Internal Medicine researchers. He advises that patients confer with surgeons about their options.
The most common procedure is mini-open repair, which uses a smaller incision than traditional open repair. To remove any bone spurs, a surgeon uses arthroscopic, pencil-size instruments to magnify and illuminate the structures inside the joint. Once that is completed, the surgeon repairs the rotator cuff through the small incision. But some surgeons are now performing the entire operation using the small camera-guided instruments, in what’s known as an all-arthroscopic procedure.
There are possible complications with all surgical procedures, of course. An Academy of Orthopedic Surgeons review of about 40 published studies showed that as many as 2% of patients have nerve injuries, while 1% may get an infection at the surgical site. About 6% may have a tendon re-tear, though that doesn’t mean a repeat surgery will be needed or that pain and poor function will result.
Lengthy Recovery
And as with any surgery, postoperative recovery depends largely on how well patients adhere to their physical-therapy regimens. Initially, that means being extra careful: A repair needs to be protected until the tendon heals strongly to the bone. Patients may be advised to use a sling for the first four to six weeks after surgery and to limit active use of the arm. Therapy usually starts with passive-motion exercises, then range-of-motion exercises continue during the next six to 12 weeks. It can take as long as six months after surgery to return to a functional range of motion and adequate strength.
Eric Taylor, a 62-year-old documentary filmmaker who plays sports like tennis with his right arm, says he was surprised when he began developing pain in his left shoulder. He tried to ease it by doing yoga, but after six months with no relief, he scheduled an MRI. It confirmed that a bone spur digging into a tendon had caused a tear in the left rotator cuff.
He scheduled surgery with Dr. Altchek at the Hospital for Special Surgery last June, but wishes he had acted sooner. Because he waited so long, he says, his surgery required three incisions instead of one. He was surprised at how much work was involved in rehabilitation but has been diligent about his recovery and physical therapy.
Back to playing tennis now, Mr. Taylor says, “When it comes to our own bodies, as baby boomers we’ve always been active, and we are going to stay active any way we can.”
A recently discovered biomarker could help doctors diagnose a common type of knee injury, according to a new study.
A team of researchers led by Gaetano Scuderi, MD, clinical assistant professor of orthopaedic surgery at Stanford University School of Medicine and an orthopaedic surgeon at Stanford Hospital & Clinics, has confirmed that a particular protein complex appears in patients with painful meniscal tears. The finding, to be published Feb. 16 in /i>The Journal of Bone and Joint Surgery, could be used to prevent needless surgery and to save billions of dollars in medical-imaging costs.
The secrets to maintaining a healthy Back
I was always of the opinion that there was too much ACLSurgery being performed. It boiled down to the QUICK FIX approach that Americans embrace. A Swedish study confirms my opinion. The Swedes make great studies because they have patients that they can follow-up for many years.Early surgery followed by rehabilitation for an anterior curiae ligament (ACL) tear is no more effective than skipping surgery and concentrating on rehab exercises, according to a Scandinavian study of young active adults.
Patients who did not have surgery reported the following:
1. better levels of pain
2. ability to participate in sports and recreational activities and knee-related quality of life, compared to those who had early surgery
They article published in the July 22 issue of the New England Journal of Medicine, on patients’ responses to the Knee Injury and Osteoarthritis Score survey 2 years after tearing an ACL.
After 2 years, 61% of 59 patients who planned to forego surgery and concentrate on rehabilitation were able to avoid surgery and reported acceptable levels of pain, activity and quality of life. “More than half of the ACL reconstructions could be avoided without adversely affecting outcomes,” write the authors.
Whether a patient should have ACL reconstruction surgery sooner rather than later also may depend on type of activities the patient does, if you are a college soccer or foot ballplayer .Then of course you need the repair but if you are a recreational athlete then give your body a chance to heal before going into surgery
The incidence of shoulder and elbow injury in young baseball players has risen significantly during the last decade. American Sports Medicine Institute have reported at least a five-fold increase in serious shoulder and elbow problems in high school and younger baseball players.
We found that even in children as young as 8, shoulder adaptations occurred in response to repetitive throwing. The growth plate of the throwing shoulder changes, leading to an increase in external rotation, meaning that with the arm out to the side, the hand can be rotated further back.
The gradual adaptations of the shoulder to throwing can protect against future injury and may increase throwing velocity. It appears that starting baseball at a young age may allow the body to gradually develop positive changes. The key, however, is that these adaptations to throwing should occur slowly over time, with adequate periods of rest. Indeed, Little League Baseball officials have tried to address some of these concerns by
2. LIMIT THE NUMBER OF INNINGS
3. NO CURVE BALLS UNTIL 14 IN MOST
4. participation in sports, with a youngster playing, say, soccer or football in the fall, ice hockey or basketball in the winter and baseball in the spring.
I have always enjoyed being athletic and have stayed in the forefront of the latest news to help me and my patients stay in shape and prevent injuries.
The truth about stretching has changed over the years. I remember when the “STATIC STRETCH” (holding a stretch for 10 to 20 seconds) was a must before an athletic activity.
SPORTS MEDICINE DOCTORS now know that the static stretch actually causes the muscle to lose 30% of its strength as well as inhibiting the opposite extremity as well.
The static stretch causes a decrease in blood supply during this time as well as buildup of various metabolites. The right way to treat your MUSCLES AND TENDONS is to warm them up before sports activity.
A slow jog around the tennis court or soccer field will accomplish this, (shoot for 30 % of heart rate and don’t spent more than 5 to 10 minutes) as well as getting you joints through a range of motion. A warm muscle is a happy muscle…it has dilated blood vessels which can deliver more O2 and remove waste.
On the other side stretching muscles while moving, a technique known as “dynamic stretching” or dynamic warm-ups, increases power, flexibility and range of motion, as well as core tempt. Of the muscle. It alerts the nervous system to prepare for the upcoming activity.
Dynamic stretching should be sport specific, just watch any pro tennis or soccer match. I have included a link to a great site for more information. http://www.squidoo.com/dynamic-stretching-exercises
Picking a running shoe is as important as picking the mattress you sleep on. When running, your foot absorbs up to four times your body weight every time your heel hits the ground, and this event is repeated almost 1000 times with every mile you run. To put it in perspective, 150 pound runner absorbs about 120 tons of force during a one mile run. Your running shoe is your first line of defense in protecting your body from these tremendous forces. Unfortunately, running shoe technology has become so advanced; it is difficult for most runners to keep up. In order to choose the best shoe for you, it is necessary to learn some basic facts about shoes, feet, and running.
First, find out what kind of foot you have…
Feet can easily be divided into three categories; low, high and neutral arches
Someone may have called you flat footed in the past, no it doesn’t mean you are slow. Stand up and put weight evenly on both feet. Look at your arches. Does your arch almost touch the floor? Does your foot or ankle roll in? People with low arches tend to have stability issues like over pronation
Is your arch really high? Can you almost fit a golf ball under your instep? The high-arched foot usually has the opposite problem. That means your foot rolls to the outside or “supinates”
Or
Lucky you, you’re somewhere in the middle – OK you’ve got lucky genes. The neutral foot is the easiest to fit and assuming you have no other structural issues you can run efficiently and comfortably with a lot of shoe designs.
.
Finally, put it all together to find the right shoe for you
Once you know about your feet and able shoes, putting it all together is pretty simple:
For flat feet and overpronators- Look for the keywords “motion control” and “stability” when shopping for running shoes.
For high arched and underpronatings- Look for the keywords “flexible” or “cushioned” when shopping for running shoes.
For normal or medium feet- Choose from a wide variety of shoes including shoes made for normal feet, shoes made for slightly flatfooted feet, or shoes made for slightly high-arched feet. You don’t want to get anything that mentions it has a lot of stability/motion control. You are also less likely to get injured, unless you pick a shoe that is counteracting your normal foot.
Finally, here are 12 simple guidelines to help you when you hit the running shoe store:
1. Try on both shoes and walk, and jog around the store. Climb stairs if possible.
2. Try on as many pairs as need
3. Make sure the shoe is padded where your foot needs it.
4. Check the quality of the shoes. Lay them on a flat surface and make sure they lay flat at the middle of the shoes. Check the quality of the eyelets stitching, gluing, and laces.
5. Make sure the shoes flex at the same place your foot flexes.
6. Try shoes after a work out and later in the day. This is when your foot is the biggest.
7. Try shoes on standing up. Allow a half inch in front of your longest toe.
8. Don’t rely on a break in period. Shoes should feel good on the day you by them.
9. The key to finding the best shoe is comfort, not price.
10. The heel should fit snugly and shouldn’t rub or slip.
11. Try shoes on with the socks you run in.
12. Sizes vary among shoe brands and styles. Chose shoes based on comfort, not the size printed inside.
13. Ask questions. Make sure the sales man is knowledgeable. If the sales person doesn’t know the answers, find someone who does.
Anterior Cruciate Ligament Substitutes … Under 40 go for Hamstrings Over Allograft BTB
The most commonly used grafts are bone-patellar tendon-bone and hamstring autografts. The improvements in fixation devices for soft-tissue grafts have popularized the use of hamstring autografts in recent years; many surgeons base their graft selection on minimizing harvest-site complications. There are substantial complications in association with the use of bone-patellar tendon-bone autograft, including anterior knee pain, pain with kneeling, loss of extension, and poorer recovery of quadriceps strength.
The use of hamstring autograft avoids these complications but has been reported to result in weakness of knee flexion and internal rotation, which may be crucial for certain athletes who rely on these important hamstring functions for optimum performance.
Sensory deficits resulting from injury to branches of the saphenous nerve during hamstring harvest have been reported. It has been well documented that the hamstring tendons regenerate, but the function of regenerated tendons has been called into question as the tendon often heals in a non-anatomic position. Tiger Woods had a hamstring graft substitute in 2009
To completely eliminate harvest-site morbidity, the use of allograft for primary reconstruction is becoming increasingly popular. The use of allograft in revision settings and multiple-ligament reconstructions will continue to be necessary as autologous tissue may not be available in these situations.
A New study , presented at the American Orthopaedic Society for Sports Medicine 2008 Annual Meeting, found that because of the almost 24% failure rate, the use of cadaver replacement ligaments might not be the best choice for young athletic patients. The older group’s failure rate was 2.4%. So although there are obvious benefits to using the cadaver ligament, such as avoiding a second surgical site on the patient, a quicker return to work, and less postoperative pain, for a young patient who is very active, it may not be the right choice.
A article in Arthroscopy in 2009″ compared, 156 (76 in the autograft group and 80 in the allograft group) were available for full evaluation. Evaluations included a detailed history, physical examination, functional knee ligament testing, KT-2000 arthrometer testing (MEDmetric, San Diego, CA), The mean follow-up was 5.6 years for both groups.
There were no statistically significant differences according to evaluations of outcome between the 2 groups except that patients in the allograft group had a shorter operation time and longer fever time postoperatively compared with the autograft group.
The postoperative infection rates were 0% and 1.25% for the autograft group and allograft group, respectively. There was a significant difference (P < .05) in the development of osteoarthritis between the operated knee in comparison to the contralateral knee according to radiographs.
However, no significant difference was found between the 2 groups at the final follow-up examination . CONCLUSIONS: Both groups of patients achieved almost the same satisfactory outcomes after a mean of 5.6 years of follow-up. Allograft is a reasonable alternative to autograft for ACL reconstruction.
