Category Archives: Workshop

Energy Drink Education – 650

Energy Drink Education; Brett Singer; Shawn Ready; Ray Olivo
Energy Drinks and Pre-Workout Supplements – What Can We Tell Our Athletes? – Brett Singer, MS, RD, CSSD, LD

Energy Drinks and Pre-Workout Supplements – What Can We Tell Our Athletes? – Brett Singer, MS, RD, CSSD, LD

Posted by Sports Medicine Broadcast on Tuesday, June 11, 2019

Contact us:

Jeremy Jackson

Shawn Readyshawnreadyatc@gmail.com

Ray Olivorayolivo1@gmail.com

Dr. Mark Knoblauchmaknobla@Central.UH.EDU

Dr. Layci Harrisonlharris5@Central.UH.EDU

Bob MarleyBob.Marley@uth.tmc.edu

These people LOVE ATs and help the SMB pay the bills:

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

Sports Nutrition with Mandy Tyler – 644

Mandy Tyler is a RD working with pro, collegiate and high school athletes in the San Antonio Area.

She joins us for some key points to remember when fueling for performance

Mandy Tyler

Fueling for performance for games and practice

Eating frequently throughout the day and establish an eating routine for each day

Improving variety in your diet

Timing and wholesomeness of the foods for snacks

Eat every 3-4 hours everyday and plan your meals out

Follow the rule of 3s (3 meals, 3 snacks)

Mandy Tyler presents 3 keys to fueling performance

Key #1 – Do Not Workout on EMPTY 

You can train your stomach like you train your lungs and muscles…work up to a regular breakfast

DON'T eat high fat or fried foods low fiber

Game Day meals closer to the event- hi-carb low protein 

Meal day before high protein (steak, spaghetti with lean meat sauce)

Key #2 – Recover after a workout

Ideal goal recover time within 30-60 min after

Fuel up as you cool down

Need carbs and protein

Freebird or Chipotle might be a great recovery meal

Key #3 Stay hydrated

Decrease performance can happen when 2-3% dehydrated

Post pee color posters in the bathrooms.

Water throughout the day and save sports drinks for competitions

An ounce is about the equivalent of a big gulp.

Need 4-6 ounces of water per 20 mins

Cool not ice cold

Drink do not pour it on your head

Supplements are NOT well regulated

If a supplement works then it might have a banned substance

You are responsible for anything you put in your body.

If it says “boost testosterone” it is likely got a steroid in it

Careful taking pre-workout because they throw everything in them

Look for third party testing for supplements

Do not model drinking energy drinks… it’s just bad practice

Food is energy

Alcohol – interferes with recovery

5 drinks delays up to 72 hours

Other points presented today:

Athletes plates versus my plate model

Olympic committee has an example of this

Consuming adequate calories and protein especially recovery

Immune Health – stay hydrated

Use herbs and spices

Omega-3 fatty acids

Increase variety of fruit and vegetables (more color the better)

Vitamin D

Tart Cherry Juice 

Probiotics 

Eating out – make the best of the worst choices

Get it on a bun

Get it on wheat when you can

Milk or juice instead of soda

Avoid supersizing

BUILDING muscle mass

Rule of 3 is important

Eating machine – schedule

Prepare meals and snacks

End day with a large evening snack

Energy Dense foods (avocados)

Weight control – do not sacrifice performance nutrition for weight loss.

Avoid sugary drinks

Nutritious snacks, lean protein to stay satisfied 

Avoid empty calories (frappuccinos, soda, energy drinks) to cut calories 

Ideal body weight has little relevance to performance. 

Focus on performance not body weight

Importance of sleep – get 30 extra minutes of sleep per night

Resources:

Scandrg.org

Sportsrd.org

Nancyclarkrd.com

We do science podcast

Mandy Tyler's Lessons learned: 

  • Nutrition common sense
  • Expect the unexpected
  • Ask questions
  • Be creative and find solutions
  • Work as a team
  • Keep learning

Facebook Live video

Sports Nutrition with Mandy Tyler

Live from the Trinity University Sorts Medicine Symposium 2020.Athletic Trainer and RD Mandy Tyler shares some of the latest tools we can use to fuel our athletes

Posted by Sports Medicine Broadcast on Thursday, 9 January 2020

Links to all the trinity live streams

Sports Nutrition; Mandy Tyler, M.Ed., RD, CSSD, LD, LAT 

Shoulder Evaluation Made Easy; Ralph “Bud” Curtis, MD 

Hip Impingement Eval; Geoffrey Glebus, MD 

When to Refer the Ankle and Foot: Timothy Palomera, MD: Link OneLink Two, and Link Three

The Throwers Elbow; Matt Holland, PT, SCS, CSCS 

Concussions are Treatable: A Multi-Modal Approach to Evaluating and Treating Concussions: Kenneth Podell, Ph.D 

Upper Extremity Neuro Eval: Jason Mogonye, MD

Spinal Deformities: Shawn Scott, DC

Contact Us

Shawn Readysready@bethpagetx.com

Marc Powell – mpowell@trinity.edu

Jeremy Jackson – @MrJeremyJackson on Facebook, Twitter, Instagram

Financial supporters

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

Hoist logo; rapid hydration; Mandy Tyler; Hoist

Why Athletic Trainers – 643

Dr. David Schmidt and Marc Powell discuss Why Athletic Trainers are so important.

Why Athletic Trainers

What was your first interaction with an Athletic Trainer?

He did not have an AT in high school

Dr. Schmidt's first experience was as a resident

He learned why Athletic Trainers are crucial…on field evaluations.

How did you and Marc Powell meet?

Marc called Dr. Schmidt pretty much everyday…then it became a habit.

Now he looks forward to the regular interaction.

Why are ATs important from the physicians standpoint?

  • unique skill set
  • on field evaluation

Share some stories

  • Dr. Schmidt always took the phone calls… every day
  • He was a mentor and allowed me to grow as an Athletic Trainer
  • Dr, Schmidt endorsed Marc and really pushed him forward
  • Marc can not shoot a deer

Did you intentionally mentor Marc Powell?

well, I did not have a choice…

I really try to treat all ATs the same

Dr. Schmidt wants each AT to know that are not an island. You are not practicing all alone.

What is an important to growth as an AT?

We need to continue to push the envelope for ATs

insurance recognition is critical

Push it forward with each setting – Tactical, Industrial, Collegiate, Secondary

How can a young AT build a similar relationship?

  • Listen
  • Pay attention
  • Ask Questions

What makes a good team physician?

Accessibility

Ability to get athletes in quickly

What are you currently doing to advance sports Medicine

  • Prevention
  • Load Management
  • Understanding the importance of recovery

Thoughts on Why Athletic Trainers are important?

Always seek to get better and tools to your tool box.

Explain who we are…just keep talking.

Contact Us:

Marc Powell – mpowell@trinity.edu

Dr. David Schmidt – Contact Marc

Jeremy Jacksonwww.SpoprtsMedicineBroadcast.com/about

Email the companies that help keep this going and say thanks

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

Concussions ARE Treatable – 642

Dr. Podell says concussions are treatable. I have traditionally heard you do not treat a concussion, instead you manage it.

Join Dr. Podell for a discussion live from the Trinity University Sports medicine Workshop 2020.

treatable, ken podell, concussions, trinity

Cervical Strain is Treatable – 3 min

Neck issues can play a big role in prolonged headaches.

Location of headaches may correlate to the c-spine that has been affected.

Role of Myodural connection – 5 minutes

“Effect of the Suboccipital Musculature on Symptom Severity and Recovery after Mild Traumatic Brain Injury”: http://www.ajnr.org/content/37/8/1556

Study done in 2016 on myodural bridge and its connection to post-concussive symptoms, may suggest that treating suboccipital musculature early on may reduce post-concussive headaches and/or other symptoms.

Neck strengthening and conditioning – 6-9 min

Neck girth and strength = reduced impact to the head and neck

Strength exercises must be done in all planes!

“The effects of rest and treatment following sport-related concussion: a systematic review of the literature”  

https://bjsm.bmj.com/content/47/5/304.long

Studies revealed that those who reported pre-season baseline symptoms had an increased risk for concussions during the season.

“Sex Differences in Head Acceleration During Heading While Wearing Soccer Headgear”

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2582549/

The study revealed that soccer females wearing headgear had greater head acceleration compared to males who had a slight decrease in head acceleration. This suggests that headgear may not be appropriate for all athletes.

Measuring Neck Strength – 10 min

“Neck Strength: A Protective Factor Reducing Risk for Concussion in High School Sports”

https://link.springer.com/article/10.1007/s10935-014-0355-2

This study showed that “smaller mean neck circumference, smaller mean neck to head circumference ratio, and weaker mean overall neck strength were significantly associated with concussion.”

Vestibular balance is also treatable – 15 min

BESS/ Sway app / Force plate

Balance work = decreased risk of lower body injuries relating to prior concussions

Vestibular-ocular – 17 minutes

“Does it feel unstable to you?” “Rocky boat” 

Are they experiencing vertigo?

Increased s/s if they were previously experiencing motion sickness

Vestibular-ocular issues are a “major source of fatigue, headaches, and cognitive problems

Vestibular Ocular Motor Screen (VOMS); 

smooth pursuits, horizontal and vertical saccades, horizontal vestibulo-ocular reflex, near point convergence, visual motion sensitivity

Home exercises; Eply/Brandt-Daroff exercises and gaze stabilization

Beginning vestibular therapy at two weeks will greatly impact and help during post concussion recovery

Training for professionals in vestibular rehab techniques is available

CAUTION! 

v-o issues may cause difficulties while driving, showering, and going downstairs

Ocular-Motor exercises 24-28 min

Newer technology;

SyncThink, RightEye, and Oculogica (FDA approved)

Home program “Eyecanlearn” (http://www.eyecanlearn.com/).

Cognitive – 29min

Baseline assessments can be viewed as more of a luxury than a necessity. 

Computerized testing;

Impact, C3 Logix, and CNS Vital Signs

Important qualities needed;

“Appropriate psychometric properties, interpretation by a qualified professional, and an appropriate environment and motivation are key factors.”

They can be more useful in RTP clearance than as a diagnostic tool.

Symptom Reporting – 31 minutes

Post-Concussion Symptom Scale can be helpful in individualizing treatment and rehab.

Psychological / Emotional – 33

Some individuals experience;

Increased anxiety levels and withdrawal (missing school, work, sport)

Depression and Poor sleep (may cause an increase in s/s)

Autonomic Dysfunction – 34 min

Damage of the long fibers that connect the brain stem and midbrain to the cortex which cause dysfunction in communication. 

This is an imbalance of the sympathetic and parasympathetic nervous systems.

Signs and symptoms of Dysautonomia:

  • Orthostatic hypotension
  • Diaphoresis
  • Blurred/double vision
  • Photophobia
  • Bowel problems
  • Exercise intolerance
  • Feeling winded
  • Insomnia
  • Dizziness
  • HR (tachycardia/bradycardia)
  • Tunnel vision
  • Weakness
  • Vertigo
  • Brain fog

Many cardio-vascular responses in concussive patients are altered. 

Assessment – 38 minutes

Ways to assess autonomic dysfunction; orthostatic BP/HR (lying and standing), exercise intolerance, Valsalva maneuver (baroreceptor functioning), HRV, head-up tilt table. 

Buffalo Concussion Treadmill Test (BCTT), assesses “physiologic measures of ANS to help differentiate if post-concussive symptoms are physiologically based.” 

Take away – 42min

After about 48hrs you can begin manual treatment of the head and neck. 

After about 72hrs, if the symptom checklist has decreased, you may begin a controlled exercise program. 

Begin treatment in the EARLY recovery phase. 

Incorporate neck strengthening as a concussion prevention tool. 

A concussion is a multi-system and functional injury that requires comprehensive evaluations.

Watch the video recording of Concussions Are Treatable

https://www.facebook.com/watch/live/?v=495289348051257

Be sure to get your free CEUs for other shows podcasts sponsored by the same group hosting the live event this was recorded at.

Complete the course work to earn Category A CEUs sponsored by San Antonio MethodistSportsMedicineBroadcast.com/CEU

Help the show keep growing by visiting the sponors:

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

PhysicalTherapy.com; 1freecourse; continued; Physical therapy, treatable

Throwers Elbow with Matt Holland – 641

Matt Holland; Thrower's Elbow

Matt Holland joins us on the podcast today from Trinity University to talk about the Thrower’s Elbow.

Why do we see so many elbow injuries in throwers?

“A great deal of stress is placed on the elbow with throwing, particularly in the late cocking and acceleration phase.  The forearm musculature has a limited ability to help with the stress load so the bone and ligaments of the elbow absorb a significant amount.”

Also contributing to the rise of injuries is the early commitment of young athletes to year-round baseball, especially in the south.  As well as great rehab that doesn’t address mechanics or the importance of core and lower extremity strength as well as balance.

Are there factors that can be indicative that an athlete may suffer an elbow injury?

Rotator cuff weakness, altered scap position, altered throwing mechanics, GIRD and not using the core or lower extremity during throwing contribute to the elbow being injured.  Dr. James Anderson states, “the #1 cause of elbow injuries is bad mechanics, and the #2 cause is overuse.  Combine those two factors and you are doomed.”

UCL tears aren’t the only injuries we see in the elbow.  What other ones might we come across?

Triceps tendonitis is common among throwers.  Most often this is an overuse issue and athletes recover quickly with rest.

Flexor tendon tears can occur but are incredible frequent especially in younger throwers.

Valgus extension overload can cause repetitive abutment of the olecranon.  It is important to look at mechanics here and ensure that there isn’t a UCL injury causing this.

Little League elbow is very similar to a UCL tear.  However the weakest link in a skeletally immature body is the growth plate so this becomes injured instead of the UCL.  The key to healing this is rest, rest and more rest coupled with parent education.

How important is rest with elbow injuries?

In a recent study published in 2019 the thickening of the UCL and the increased joint space of the elbow found in thrower’s experiencing elbow pain returned to normal on imaging after rest.  However, if these athletes had GIRD that wasn’t addressed, that correlated with a continued increased joint space in the elbow.

What questions should we ask an athlete who comes to us with elbow pain?

What position do you play or combination of positions?

What is your volume of play?

Do you take time off?

Where is your motion does it hurt? 

This question is of particular importance because if the pain is happening during the maximum external rotation found in late cocking it is usually a UCL issue.

What are the rehab guidelines post-TommyJohn surgery?

Protect the graft for 6 weeks and return normal strength to not only the elbow but to the shoulder, core and lower extremity.  Focus on balance and at the 4-5 month mark throwing can begin.  It is a long process because once throwing is started that is how we strengthen the ligament with little stressors.  Throwing should include working on mechanics but stressing the ligament a little bit followed by rest.  It’s also important to note the type of revision done because some revisions like the modified Jobe move the nerve and this becomes important to know while doing soft tissue work.

Does the UCL reconstruction have favorable Return-to-play?

Yes!  90% of post-surgical patients return to normal throwing biomechanics post-surgery.  

What is important to remember regarding elbow injuries in the throwing athlete?

Great rehab is important but it doesn’t help if it is coupled with poor mechanics and it is critical that we have continued conversations with parents educating them on detrimental effects of year-round throwing in high volume without rest.

High loads with high-speed movements

Angular velocity of the shoulder is anywhere between 7 to 8 thousand degrees per second as the shoulder does from max external rotation to an internal rotated position. Then the elbow goes from a flexed to an extended position at 3 to 4 thousand degrees per second in which if there is a small break down in mechanics, strengths, and/or anatomical structure thats when things begin to go sideways. 

Phases of throwing

Wind up: is when the athlete begins to move. 

Early cocking (stride): In this phase the hands break and the arm moves into adduction, stride length increases the distance in which acceleration occurs so its basically storing the kinetic energy. Pelvic tilt and rotation also happen in this phase.

Supraspinatus, infraspinatus, and teres muscles act late in order to get your arm into an externally rotated position. The phase ends as the lead foot hits the ground. Due to the minimal involvement of the muscular structures, this is known as the power position of the shoulder. 

Late cocking: In this phase this is when things begin to fire up. 

From lead foot contact to max external rotation then when you add stride component and spine tilt that is when your arm is laid back from 165 to 180 degrees.  Due to the angle of pull of the supraspinatus this provides glenohumeral compression at this time.

Max pelvic rotation and trunk rotation velocity. At the end of this phase, when your arm is laid back into max external rotation, the subscapularis, pec major, and latissimus dorsi all fire eccentrically in order to stop your arm from laying back completely and they also stop external rotation. The elbow has the most stress. 

Due to the amount of stress at the elbow site, an elite fast ball is enough to tear the ligament if you were to repeatedly do that motion in a lab. “Everytime you throw a fastball its 35 newtons, at 33 newtons is what it takes to break a ligament in the lab”.

Acceleration phase: This is from the max external rotation position until the ball is released. The scapula has to retract and anteriorly tilt with serratus anterior creating the shoulder muscle forces that was slowing your arm down, are now shifting to concentric in order to create the acceleration to throw the ball. 

Subscapularis activity is at its highest and this is also where you get the max 3 to 4 thousand degrees per second of the elbow going from a flexed to an extended position quickly. 

Deceleration (ball release): This is considered to be the most violent phase for the shoulder, not so much to the elbow. There is an excessive distraction, posterior sheer, and high eccentric loads to the posterior cuff as well as an incredible amount of eccentric bicep activity in order to slow the elbow down to keep it from going into full extension.

Cocking, ball release and acceleration are the primary phases that you will see the most problems in.

Factors affecting injury

RC weakness

Altered scapular position

DIRD

Decreased use of LE/ Core

Decreased balance

Poor mechanics

Throwing Mechanics

Must address throwing mechanics in order to promote return to throwing after injury

Volume discussion in youth baseball

Dr. Andrews – 

#1 is overuse

#2 is bad mechanics

If you have both you are … doomed

Pathomechanics – 11mins

Muscle contribution

Soft tissue

Flexor-pronator tendinitis – pain felt at ball release and not during the cocking phase of throwing.

Really common early in the season

Flexor tendon tears – not common 

Nerve injury – more in adults

Numbness in 4th and 5th finger after throwing

Ulnar nerve subluxation

Bony Injuries – 15 min

Valgus extension overload

Radial capitellar joint

Little league elbow – 17 min

REST

Parental education is critical

Increased with year-round play

Growth plate is often weakest

Elbow ROM in pro pitchers

Elbow extension dec by 8 deg

Flexion dec by 6 deg

Total flexion ext arc dec by 15 deg

Flexion contractures up to 25deg deficit

Questions to ask

Position played

Volume

Baseball only

Year-round baseball

How much time off

How long have you been off throwing

Where in your motion does it hurt

UCL injuries – 22min

Rest from throwing 6-12 weeks

Normal cuff and scapular strength

Normal scapular control

Restoration of normal IR

Throwing Mechanics correction

Interval throwing program critical

UCL with internal bracing

Similar to ACL internal bracing

Much faster than a traditional UCL reconstruction

Balance and UCL tears – 26 min

In a study done by Craig Garrison from Fort Worth looked at 30 guys with UCL tears and without. The guys with tears showed a decrease in single leg with the Y balance test compared to the guys without the injury. So, if you have a kid who comes up and can't hold their balance and drops their elbow putting their elbow in a bad position those are the kids who get hurt. 

During Rehab, by week 4 post-op you should be having these kids doing a lot of core, hip, and balance exercises then look at the shoulder. 

UCL Surgery – 

The elbow is made up of 2 bundles, the anterior and posterior bundle. The Anterior bundle is the main focus when talking about UCL surgery. It runs from the inferior aspect of the medial epicondyle and inserts into the sublime tubercle. The posterior bundle is pretty much the floor of the cubital tunnel. In the anterior bundle, you have an anterior and posterior band, the posterior band is the one that gets injured in baseball players. It primarily restrains valgus stress throughout its functional range of motion.  

Importance of rest

Preseason GIRD vs post season – baseline returned to normal after 6 to 8 weeks of rest.

IT WENT BACK TO NORMAL WITH 6 WEEKS OFF

Shoulder tightness increases the risk of elbow injury

Only 42% of MLB pitchers with TJ returned to pitch 10 games or more.

Cost of TJ in MLB – $395 million average of 180 days

Biomechanical evaluation – 36 min

After shoulder surgery, you lose horizontal extension and external rotation which are two critical components in throwing. 

RTP after shoulder surgery in baseball is at best 60%

Watch Matt Holland on Facebook Live

Throwers Elbow – Matt Holland

Live from Trinity Universty Sports Medicine Symposium 2020.Matt Holland PT, SCS, CSCS helps us get ready for the start of baseball and softball season.

Posted by Sports Medicine Broadcast on Friday, 10 January 2020

Contact us

Jeremy jackson

Matt Holland

Shawn Ready

Sponsors help keep it going…help them keep us going

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

FrioHydration; frio hydration; Get Frio; Best in class; Waterboy; wisstech; hydration station; sports medicine broadcast; Jeremy Jackson; Rob McFarlin, Matt Holland

Easy Shoulder Evals – 640

Dr. Ralph “Bud” Curtis goes live with Easy Shoulder Evals from Trinity University's Sports Medicine Symposium 2020.

About Dr. Curtis:

  • 15 Years as being recognized as a Texas Super Doctor. Dr. Curtis has been recognized every year since 2005.
  • Fellowship-trained shoulder surgeon
  • Board of Directors, THSCA Professional Development Curriculum
  • 30 years, UIW
  • UIW Sports Hall of Fame
  • Shoulder consultant: S.A. Spurs, UTSA, Trinity Univ., UIW
  • Hall of Honor THSCA
  • Hall of Honor Southwest Athletic Trainers Association
  • Author of multiple book chapters on shoulder injuries
  • Adjunct Professor, Department of Orthopaedics, UT Health
Easy Shoulder Evals

HAVE A SYSTEM

Needs to be quick and reproducible

Make sure it is age-based and know what is most likely for each age group

Understand traumatic vs non-traumatic

HS to the college level is most likely instability

Sitting fashion helps them relax

Try not to fight them

Find out the background before ever touching the patient

Then the provocative tests

Sulcus test

Load and shift – generalized laxity, not traumatic instability

Neer impingement test is a pretty lousy test

Hawkins impingement test

Anterior apprehension for anterior instability

Posterior instability including the jerk test

AC joint pathology is going to be painful so it confuses the test

Palm down O’brien’s test for SLAP

Anterior dislocation – check to see if there is good smooth motion internally and externally

Posterior instability the converse is true.

These often get missed because they look normal until follow up with ortho.

Once dislocation is reduced check for full internal and external rotation.

ANTERIOR INSTABILITY – 18 minutes

Look at ROM 

Click test is something that can be beneficial

RCT –

Empty can is often normal due to deltoid 

Arm inside external rotation

Stinger / Burner

C5/C6 

Deltoid weakness

External rotators weak

Possibly weak biceps

C7 cervical disk

Strong delts and biceps

Triceps are totally weak

C8 is ok (can keep fingers spread)

Watch the Easy Shoulder Evals Facebook live video

Resources

Other shows from Trinity University's Sports Medicine Symposium 2020

Contact Us

Jeremy Jackson

Shawn Ready

These people LOVE ATs and help the SMB pay the bills:

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

Hoist logo; rapid hydration

Upper Extremity Neuro Evals – 637

Dr. Jason Magonye and Dr. Shawn Scott put together and Upper Extremity Neuro Eval session at the Trinity University Sports Medicine workshop.

Upper Extremity Neuro Eval

Complete the CEU course FREE from Methodist San Antonio

Be familiar with the nuero anatomy of the upper extremity

Cranial nerves – remember they are contra lateral

Dermatomes – sensory innervation to the upper extremity

If it is intact distal, it is intact proximalStart distal and work proximal

Brachial Plexus – 11 min

Latisimus dorsi is the ladder climbing muscle

Subscapular – don’t let them pull their hands off their belly

Supraspinatus – starts abduction until the deltoid takes over.

Hornblower test – teres minor

Ulnar nerve (C7/C8-T1)

Median Nerve (C5-C8, T1) tip of fingers, the palm of the hand

Anterior Interosseous Nerve (AIN) 22 min

Radial nerve – extension nerve (C5-T1)

Posterior interosseous nerve – supinator

Most of the extensors

Nerve Entrapment -24 min

When nerves get entrapped they get irritated.

IF YOU CATCH THEM EARLY YOU CAN PREVENT THE NERVE DESTRUCTION PROGRESSION.

If they are having weakness then we need to really push to have that person looked at

Median nerve entrapment

Pronator syndrome is similar to carpal tunnel syndrome.

Carpal tunnel – positive tinels or phalens

Pronator teres syndrome.

Catch the rest in the podcast or on Facebook.

Do not be afraid to ask your athlete to provide copies of imaging and reports.

Case #1

16 year old football player who presents with bilateral hand pain. Pushed from behind during a game and landed face down with his hands in front of his body. 

During further questioning of his hands symptoms he states that both of his middle fingers were tingling. 

Due to the fact that the patient is experiencing bilateral symptoms you must go to the source in which would be the spine (C7 nerve)

Ulnar nerve splits the 4th digit. 

If you have someone who presents with tingling and numbness on the inner aspect of the hand you know that is C8. 

Radial nerve does not go to the tip of the fingers. 

Case #2 

Saddle bronc rider came off his horse and landed on his head. He walked out of the arena and did not complain of neck, head, or arm symptoms. After driving from Colorado to Texas he went to the sports medicine room stating that he had started to experience bilateral middle finger tingling sensations.

Worse thing to do when you have bilateral symptoms, trauma, and numbness and tingling would be to compress the neck. 

Range of motion, neurological testing, and gentle palpation are appropriate to perform in the exam. Orthopedic testing would not be appropriate for this exam. 

During exam in both case 1 and 2:

Flexion/extension movements caused finger sensations. 

Palpation produced “unusual neck pain” at this point your exam is done 

Both cases were referred for immediate cervical xrays. 

Case #1 Xray findings: Flexion tear drop fracture of the C5 vertebral body with grade 1-11 retrolisthesis of C5 and C6. 

Both of them had surgery the next day.

Catch the rest on the podcast or watching the Facebook videos.

Upper extremity Neuro Eval – Jason Mogonye

Upper extremity neurological evaluation with Dr. Jason MogonyeLive from Trinity Sports Medicine Symposium 2020

Posted by Sports Medicine Broadcast on Friday, 10 January 2020
Spinal Deformities with Shawn Scott

Live from Trinity Sports Medicine Symposium 2020

Posted by Sports Medicine Broadcast on Friday, 10 January 2020

Contact us:

Jeremy Jackson

These people LOVE ATs and help the SMB pay the bills:

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

Upper extremity Neuro Evals

Diagnostic Accuracy – 635

Do you personally have a Diagnostic Accuracy cutoff in terms of diagnostic factors to determine if you would use the test?

No, but if there are multiple tests available I look at the most accurate ones. I do not really like it when clinicians do every test available just because.

Diagnostic Accuracy

Are we image happy?

X-ray, MRI, Ultrasound – it is visual, so it gives us something to see

But blood tests do not really give us that.  It has to be done against controls.

Having every injury get an MRI would be great, but it is cost-prohibitive for a lot of people

“If we are sending every patient to get an ultrasound image, then why are we there?”

Talk about treating the patient vs treating the image or diagnostic test.

  • In Athletics, the nice thing is most injuries are life-threatening.
  • But for internal injuries MRIs are lifesavers.

It is hard to argue with an x-ray showing a fracture

What is the conversation you would have with parents before the season begins about your confidence in your evaluations and role at the school?

If I think we can treat them here we will if I think they need imaging I will refer them to our team doctor and he can order the images.

Mention this though: “a non-sports medicine doctor will likely default to out two weeks”  once they do that we are obligated to follow that before beginning rehab and return to play work.

Is there any uncertainty in using diagnostic accuracy values in Athletic Training?

YES!  There is untold value – the new ATs have learned this but it is a new development in AT education.

How do we make Diagnostic Accuracy Language more universal?

It is growing as we have more and more ATs learning about it as part of their education.

More talks at conventions with catchy names

When would you not focus on diagnostic accuracy measures?

In short, yes you can go with your gut and try a few other tests when things seem off.

How do you get students to buy-in?

This is how you win arguments.

If someone questions you and your evaluation you Have numbers and research to back it up…this usually will end the argument.

Make them understand it is not just statistics.

Some orthopedic tests have minimum research or no reported value, where does proof of the value come in?

Yes, you can still do the test if there is a value that is not reported.

Usually, this requires MRI proof.

Some conditions do not have a good test

Diagnostic Accuracy” – Mark Knoblauch, PhD, LAT, ATC, CSCS

Diagnostic Accuracy” – Mark Knoblauch, PhD, LAT, ATC, CSCSAsk your questions LIVE from the Memorial Hermann Sports Medicine Update 2019 in Katy, Texas. We hope to include your questions in the follow up interviews that will be edited and released later.

Posted by Sports Medicine Broadcast on Tuesday, June 11, 2019

Contact us:

Jeremy Jackson

Shawn Readyshawnreadyatc@gmail.com

Ray Olivorayolivo1@gmail.com

Dr. Mark Knoblauchmaknobla@Central.UH.EDU

Dr. Layci Harrisonlharris5@Central.UH.EDU

Bob MarleyBob.Marley@uth.tmc.edu

These people LOVE ATs and help the SMB pay the bills:

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

Dislocation Management – 633

What is your plan for Dislocation Management?

Ray Olivo sits down with Dr. Mundluru after his Dislocation Management presentation at the Memorial Hermann Sports Medicine Update.

dislocation management; ray olivo; mudluru

Anterior Shoulder Disloaction

ALWAYS do a neurovascular assessment. Every single dislocation should experience this before reduction.

With the Shoulder there is a risk of axillary nerve entrapment

Typically if the nerves are intact distally then they are intact all the way up the nerve, therefore do your nerve tests at the distal end of the limb.

A dysvascular limb becomes a medical emergency so do a pulse check on both sides. double and triple check if there is no pulse as some are harder to palpate

Dr. Mundluru also recommends having the functional tests distal to check nerve and muscle function

  • OK sign
  • Thumbs up
  • Cross fingers
  • Scratch test

Repeat the scratch test at the deltoid and check bilaterally having the patient note any difference in sensation

A good motor assesment for dislocation management is having the patient press backwards at the elbow into the examiners hand. most other ROM tests will be limited or elicit pain.

They also discuss:

  • Brachial Plexus Crush
  • Transient symptoms after dislocation
  • Self-Reduction
  • Sports Specific RTP
  • When does it become surgical?
  • Elbow Dislocations
  • Hip Dislocations
  • Patella and Knee

Whenever possible treat young patients non-operatively.

Have stories of Dislocation Management gone well or poorly?

Send us your stories:

Dr. Mundluru

Jeremy Jackson

Shawn Readyshawnreadyatc@gmail.com

Ray Olivorayolivo1@gmail.com

Dr. Mark Knoblauchmaknobla@Central.UH.EDU

Dr. Layci Harrisonlharris5@Central.UH.EDU

Bob MarleyBob.Marley@uth.tmc.edu

These people LOVE ATs and help the SMB pay the bills:

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.

McDonald; Dermoneuromodulation; Medbridge; CEUs Online CEUs; affiliate link
use “THESMB” to get your discount

Imaging and Sports Injuries – 624

What's the role of Imaging and Sports Injuries

Dr. Manickam “Nicks” Kumaravel, MD shares what the current and future role of imaging and sports injuries are at the Memorial Hermann Sports Medicine Update.

Dr. Mark Knoblauch shares the mic as we are live in Katy, Texas learning.

Imaging and Sports Injuries

What is a normal day like for radiologists?

Most are sitting in front of a computer looking at images, coming up with a diagnosis, and sending them back.

Dr. Nicks has a unique set up as he has a viewing room in the middle of the ortho floor. He regularly gets out of the office to interact with doctors and patients.

He, at times, even scrubs in with the surgeons to help and learn.

How much info are you usually given with the images to make a diagnosis?

Usually one or two lines at most. This is part of the reason he gets out of the office to see and interact with the doctors.

“Garbage in gets garbage out” plays true in imaging and sports injuries too.

Are there specialties in radiology as well?

Absolutely, If Dr. Kumaravel were to get a neuro MRI he would be sending it right along.

Where are we headed with Imaging and sports injuries?

Clinical Skills need to be an emphasis in radiology education. We are moving away from using clinical skills and he believes it is showing in the results.

Continued improvement and growth. we are now able to see bone marrow edema with CT scans

Ultrasound is the next big wave in the United States. It is becoming an extension of the physical exam.

The hardest part about an AT using the US machine is knowing what it means and interpreting the results.

Cinematic renderings are amazing to see as well.

Watch the presentation on Facebook

Imaging and Sports Injuries – Manickam "Nicks" Kumaravel, MD, FRCS (UK)

Imaging and Sports Injuries – Manickam "Nicks" Kumaravel, MD, FRCS (UK)

Posted by Sports Medicine Broadcast on Tuesday, June 11, 2019

Contact us:

Dr. Kumaravel

Jeremy Jackson

These people LOVE ATs and help the SMB pay the bills:

Frio Hydration – Superior Hydration products.

MioTech – meeting all of your sports medicine supply needs

PhysicalTherapy.com – use promo code “1FREECOURSE” to start for free

DragonflyMax – one-stop EMR

HOIST – no matter your reason for dehydration DRINK HOIST

MedBridge Education – Use “TheSMB” to save some, be entered in a drawing for a second-year free and support the podcast.