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

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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

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Shawn Ready

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COVID19 RTP Recommendations – 639

Have you prepared your COVID19 RTP plans?

Bart Peterson and Jennifer Rheeling join the SMB to discuss the current recommendations and considerations created by the NATA Secondary Schools Athletic Trainer Committee to help you create your COVID19 RTP.

COVID19 RTP

We need to reconsider EAPs to include social distancing guidelines.

What about lightning…now, where will they go?

Know what phase of COVID19 RTP you are in from the local public health department.

Know the terminology and how its is defined:

Phase 2 is groups of 50.  Is that on the field or altogether outside at once?

Covid response team

Who is on yours?

They need to know what the plan of action is if you have a room full of kids and one test positive with temps or signs and symptoms.

ATs are a key component in risk mitigation

Being part of the decision-making process is important.

We also have to know how we are going to take care of the over 55 population…coaches, teachers, and officials.

Communication with the school nurse is crucial and this is a great way to build the bridge.

Cleaning Supplies

Districts may need to buy them out of another fund or fund next years purchases now even though budgets have not opened

Hydration

NO water sources until phase 3

Illness Reporting – start with the state, including local, report up the chain. 

Telemedicine –

Congress made this easier during COVID19

Need consent each time you do a telemedicine video

Can not cross state lines

Document as normal

Know your platform

Make sure that this is not occurring in a bedroom

Facebook Video of the COVID19 RTP talk

COVID19 RTP Guidelines explained

COVID19 is changing everything we do as medical professionals.Join Bart Peterson and Jennifer Rheeling to discuss the newly released COVID19 Secondary School Athletic Trainer Committee guidelines. This will be SportsMedicineBroadcast.com/COVID19RTP for links and contact info.COVID-19 Return-to-Sport Considerations for Secondary School Athletic Trainers – https://www.nata.org/sites/default/files/covid_19_return-to-sport_considerations_for_secondary_school_ats_1.pdfTelehealth Guidelines for the Secondary School Athletic Trainer – https://www.nata.org/sites/default/files/telemedicine_guidelines_for_the_secondary_school_at_0.pdf

Posted by Sports Medicine Broadcast on Thursday, 4 June 2020

Resources:

COVID19 RTP Document

Telemedicine

Contact US:

Jeremy Jackson

Jennifer Rheeling email – jennifer.rheeling@gmail.com

Jennifer on Twitter

Bart Peterson – email – arizatc@cox.net

Bart on Twitter

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Candid Candidates – 638

NATA 2020 presidential Election has Candid Candidates

Chad and Kevan host Candid Athletic Training where they take a look at Athletic Training very candidly.

Kathy and Katie are used to answering questions about Athletic Training and fixing what is broken. We wanted to have some very Candid Candidate discussions to help you know your next NATA president.

Why would your undergraduate mascot make the best Athletic Trainer

KF: Beaver: adaptable, ferocious, make a phenomenal home from out of nothing, leaves everything better than it found it.

Being a team player, quietly getting things done under the radar

KD: Longhorn – Magnanimous animal

Quiet, slow-moving; large and graceful

If you get in the ways of the horns you will regret it.

Rehab specialty: Administration – quiet, contemplative

FMK

KD:

K – Cat D – I want it to be applicable and pertinent

M – EBP – a lifelong commitment to learning

F – Lecturing – it is a rush to share that knowledge

KF:

F – Cat B

M – EBP

K – the Cat D

What will you miss most about the COVID19 2020 convention cancellation?

People, socials, energy, relationships

Mount Rushmore 4 things you feel young ATs will face and need to be prepared for

KD:

  1. Give your self a break…there is a lot to learn
  2. Professional Communication
  3. Continue to learn
  4. Advocacy and showing your value is CRUCIAL 

KF:

  1. Follow your contract – Do not give your time away for free
  2. Policies – have those ready and follow them
  3. You Are Enough…
  4. Mentor over Data

How do you negotiate time for yourself?

KF: your first job is the only one where you might not negotiate…after that it is on you

KD: We are not training our students to negotiate.

How are you going to best get your objectives communicated to people?

KF: NATA News

Be responsive to the people

Be everywhere

KD: Diversity in mediums

Being willing to reach out on all of the different mediums.

Kathy prefers face to face or phone call, but currently have to respond and react.

Opinions on the dangers and benefits of Social Media

KF: uses it as a positive outlet 

FB, Twitter and IG

It is irresponsible to hide behind the account

It is a good source of what ATs are thinking and feeling

KD: Hardest thing is to keep up with all of the platforms

SM can really help reach people

It is really easy to anonymously complain…but is your message getting through if you are hiding.

“We learn the most from people who are unhappy”

Hats – Clinicians, educators, legislation

KD: We all have some of those roles with a focus

  • Feels it is more regarding settings vs roles

KF: I do all three of them

  • The researchers are valuable

Retention Rates in AT

KF: became members of American Advisors for allied health professionals

  • The continued growth of opportunity
  • It is a barge, so we can not turn on a dime

KD: 

  • Supply and demand
  • Negotiate contracts
  • Can we improve life balance in the traditional setting.
  • Non-traditional settings will likely bring the secondary setting up due to economics

Watch Candid Candidates

Candid with the Candidates

Chad and Kevan bring their Candid AT-style to interview Kathy and Katie before the upcoming 2020 NATA Presidential election.

Posted by Sports Medicine Broadcast on Thursday, 21 May 2020

Contact Us:

Kathy Dieringer

Katie Flanagan

Candid AT

Previous podcast with your candidates:

Presidential Discussion

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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

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Upper extremity Neuro Evals

Dance Medicine with Jatin – 636

What do you know about Dance Medicine?

Jatin Ambegaonkar joins Sarah Gill live in the expo hall in Las Vegas during the 2019 NATA Convention.

Jatin; Dance Medicine; Sarah Gill

What are y'all doing at George Mason

Started in 2007 with a strong dance program, but no medical support.

Documentation!!!! This showed it needed a more a attention and resources for the performing arts facility

Clinical and research area fed off each other

Aesthetic Athletes

How does this impact the way you work with the athletes?

It changes a lot of things…nobody cares what an NBA player looks like jumping and landing.

These athletes need to know their maximum and work below that…what is the maximum you can perform and still maintain your game face

It needs to look effortless and easy

We as AT are tasked to knowing when to push through and when to back off.  Jatin, how do we know where the line is?

They need to recognize the 5 signs of inflammation

Heat

Swelling

Redness

Loss of function

Pain

Only 28% of dance athletes have specific healthcare access

We are focusing on empowering them to know when and how to reach out

How is your interaction with your instructors, choreographers?

Similar to a coach, but possibly a stronger bond to coach than the health care provider

Talk some more about your SMART lab

Collaborative endeavor: Sports Medicine Assessment Research and testing lab

15 years old now

Performance improvement across the life span of physically active people

Determine the quality of life the patient desires

Looking at dance to reduce the risk of obesity in middle schools

Focuses on benefiting the athletic community as a whole.

Recommendations for a small school or dance medicine clinic?

The buy-in is more important than the actual facility or equipment.

KEY – recognize who these people are and what the demands placed on their body

Pilates reformer

A full-length mirror is very important for this crowd.

Standard basic injury care gear

What does return to activity after concussion in the performing visual arts

No consensus yet

Focus on return to learn

Mimic the athletics model – warm-up at a symptom-free, gradual return to participation.

Most concussions for dance are in training rather than the performance which is the opposite of athletics.

Early Return to Activity – 

Issues with the cognitive portion

Take-Home Points

  • Recognize there is a need for the healthcare of this population.
  • How to speak their language and listen to them
  • Treat them as a whole person rather than an ankle injury or knee injury
  • Allowing them to work around the team decreases the social isolation and improves recovery more in this population

Does Jatin Dance?

At weddings he can get down and enjoys himself…even if others do not.  It is about having fun

Not everybody needs to be a good performer to dance.

Other Dance Medicine podcasts

Dance Medicine with Daria & Carina – 457

Cirque de Soleil – Jatin Ambegaonkar and Sarah Gill

Dance Medicine – Dr. Jatin Ambegaonkar and Sarah Gill

Posted by Sports Medicine Broadcast on Wednesday, 26 June 2019

Contact us:

Jatin – jambegao@gmu.edu
Facebook
Twitter

SmartLabs on Twitter

Sarah Gill – On IG @SarahGillATC

Jeremy JacksonHost of The Sports Medicine Broadcast

John Ciecko – jciecko@bloomfield.org

Alisha M Penningtonalisha@theatvantage.com

Mike McKenney – m.mckenney@northeastern.edu

Mike Hopper – Mike.Hopper@bishoplynch.org

Clint Sanders – clint@dragonflyathletics.com

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

Frio Hydration – Superior Hydration products.

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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

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

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Presidential Discussion – 634

NATA Presidential candidates Kathy Dieringer and Katie Flanagan join Cari Wood in answering some member-driven questions.

Presidential Debate, presidential discussion, Katie Flanagan, Kathy Dieringer, Cari Wood, NATA, President, election, 2020, COVID19

Jill A. asks – Licensing in California – what’s the plan?

Katie Flanagan (KF): We need to pull back, circle the wagons and reconsider it

Kathy Dieringer (KD): It has gotten to the Governor’s desk multiple times…then vetoed but it does not pass due to politics. There is no lack of effort, but there are organizations working against us.

  • Continue to be persistent

Chris P – How will we work to expand Diversity in our field?

KF: Tripled our membership in 20 years but only increased diversity 3%

  • Diversity wins

KD: Diversity makes us stronger

  • NATA membership stat is about 80% caucasian
  • Other than the board our leadership does not reflect this number

Jeff K – What suggestions do you have for ATs to sustain viable employment due to the lack of sports?

KF: The secondary setting is hugely important and is a portion of what we do.

  • Use Go4Ellis
  • Be flexible and keep growing your skills
  • We need to think forward
  • Reach out to the NATA for additional resources

KD: We do not even know what is coming

  • We are great at responding and shifting
  • Advocate for yourself
  • Maximize your skillset
  • “Can I teach something else?”

Adam – What is the presidential plan for AT growth in rural areas?

KD: All about advocacy, collaboration with NFHS, principals…going to those meetings and getting facetime with those folks.

KF: Empower the local people and walk alongside them.

The NATA may be facing some financial difficulties due to canceling the annual convention.   How do you see that affecting the membership?

KD: Convention is a revenue producer, many ATs have been laid off.

  • What are the financial implications? this has to be considered.
  • Past treasurer of NATA
  • My business background will serve us well in this situation

KF: NATA has been very financially responsible and relies on several checks and balances.

  • NATA Offered ACES prep exam for the students getting ready for BOC exam
  • Creative thinking will be required

Secondary Schools – 

KD: It is where athletes are introduced to the AT for the most part

  • Collecting Data
  • Medical Autonomy
  • Pointing towards available resources
  • Monthly calls with chairs of committees and workgroups “What is working and not working?”

KF: they have rural and urban school settings and her students get to experience different settings.

  • The AT becomes the gatekeeper for the small schools and urban schools alike
  • Need to be flexible and know the situation to make them successful in that setting
  • Investigate equal representation for each type of secondary school

 Should we teach Sports Medicine in high schools:

KF: ATs are now has a seat at the table on the high school medical education

  • I could not do my job without my students…that creates a problem
  • Have them help collect data to show the need for help.

KD: HS ATs have a skill set of teaching

  • They are our preceptors…its what they do
  • The introduction to health professions is VERY important
  • Caution about teaching students skills that should only be practiced by and LAT BOC person
    • Student ATs were attending to the kid with a spleen injury…he almost died.
    • Perception is difficult when people think the students can do your job

Final Presidential Discussion remarks

KF: “I do not want to pretend to know everything.”

KD: “The most important thing is to be unified as a profession moving forward”

Presidential Discussion

Your 2020 NATA Candidates join the SMB for a round of answering your questions.Submit your questions here, via messenger, or via email to info@sportsmedicinebrodcast.com

Posted by Sports Medicine Broadcast on Thursday, May 7, 2020

Contact us:

Jeremy Jackson

Cari Wood – cari.wood@redmondschools.org

Kathy Dieringer – kidier@ddsportsmed.com

Katie Flanagan – FLANAGANK@ecu.edu

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MioTech, Presidential Discussion, NATA President, 2020 Election, Kathy Dieringer, Katie Flanagan

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

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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.

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Ramadan Tips for ATs – 632

Intermittent fasting and Ramadan tips are important considerations Athletic Trainers need to know about and be prepared to care for.

John Ciecko joins Registered Dietitians Kyla Cross and Melanie Battaglia to give some specifics and general considerations.

John has put together this letter for his coaches and athletes

Ramadan Tips for Diet

It has been widely recommended that athletes partake in multiple meals throughout the day in order to maintain the energy necessary to participate in athletic events. Most Muslims will automatically adjust their meal frequency to two meals in a 24 hour period, the Suhoor (early breakfast) which takes place at dawn and the Iftar which takes place just after sunset. The challenge is created as student-athletes find it more difficult to eat healthier meals as each Iftar is generally composed of meals that are high in fat, sugar, and salt. It should be noted that meals at both Iftar and Suhoor generally meet the daily caloric needs for student-athletes they may lack proper nutrients that are essential for optimal performance. 

Since the daily caloric value is generally met by student-athletes it is important to pay particular attention to the macronutrients (fats, carbohydrates, and protein) consumed. It has been recommended that foods high in both fat and protein are consumed during Iftar and that foods high in carbohydrates and low in glycemic index are consumed during Suhoor in order to provide adequate fuel for the day. 

Hydration

Lack of fluid intake throughout the day can create significant risks for those who participate in physical activity during Ramadan as most athletic events take place while Muslim student-athletes are fasting. A common occurrence for student-athletes is to ingest large quantities of fluids during hours of allowed fluid intake. This practice can prove ineffective as it will induce urine loss as well as disrupt sleep. It is recommended to drink water frequently in shorter intervals with solid foods during meals to aid in digestion and water retention. Another recommendation is to drink water with a marginal amount of salt and/or electrolytes prior to dawn to improve water retention and stores. Sugary and caffeinated drinks should also be avoided as they can cause further dehydration.

Sleep

Disruption in sleep will cause daytime fatigue and poor concentration. Coupled with a new fasting cycle, student-athletes may find it difficult to maintain a level of physical performance prior to Ramadan. Student-athletes are recommended to maintain a minimum of 8 to 9 hours of sleep a night. Since meals that break the fasts can often disrupt sleep cycles, student-athletes are encouraged to partake in naps in which they can obtain between 1.5 to 2 hours of sleep in the afternoon when able to in order to negate the effect of nocturnal sleep loss. 

Considerations for Coaches and Medical Emergencies 

Coaches and staff must always be aware of and sensitive to all student-athletes needs both religious and non-religious. It is important during this time that coaches routinely collect feedback from student-athletes but not to do so in a way that draws attention to a student who is practicing a religious observation. It is also important for the student-athlete to make the coaches aware of their practice, as fasting during Ramadan without knowledge can be misconstrued as a lack of effort or performance without the knowledge of these recommendations. 

One consideration to keep in mind is the early days and weeks of a new fasting cycle, is the disruption of a student-athletes ability to self regulate their body temperature during activity without the use of fluids. Student-Athletes will have access to cooling towels during athletic events as well as small cooling tubs in the Athletic Training Room. Student-Athletes are able to rinse their mouths with water in an attempt to stave off thirst but in the event that a medical emergency is believed due to dehydration and/or increase in body temperature, it is allowed to give fluids to the student-athlete and activate the Emergency Action Plan. In any instance, regardless of religious views or practices, all student-athletes should be treated equally as to not draw attention to their needs. 

Please inform booster families that student-athletes may attend, but will not be able to participate in pasta or pizza parties that take place during the season. In addition please inform banquet planning families to consider providing a take-home option during the postseason banquets. Even though there will be plenty of food for them at home, the notice and consideration will not go unnoticed by the student-athlete and their families.

Internet dropped so we have part one and part two on FB

Ramadan Tips for ATs

We are approaching the Ramadan season again.Two RDs in the Gatorade fellowship program have joined us today as well. Melanie Battalagia and Kayla Cross. They are working with Brett Singer out of Memorial Hermann's Ironman Institute.Interesting enough we may not even need to consider what is required in treating the atletes observing Ramadan as COVID`9 has pretty much shut down all athletics across the country.

Posted by Sports Medicine Broadcast on Thursday, April 9, 2020

Ramadan part two

Ramadan Tips for ATs

We are approaching the Ramadan season again.Two RDs have joined us today as well. Melanie Battalagia and Kyla Cross. They are working with Brett Singer out of Memorial Hermann's Ironman Institute.Interestingly enough we may not even need to consider what is required in treating the athletes observing Ramadan as COVID`9 has pretty much shut down all athletics across the country.

Posted by Sports Medicine Broadcast on Thursday, April 9, 2020

Contact us

John – jciecko@bloomfield.org

Kyla Cross – kycross@umich.edu

Melanie Battaglia – melanie.battaglia@memorialhermann.org

Previous Ramadan Podcast

Ramadan and Athletic Health Care – 546

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