Concussion technology has come a long way in helping us understand and manage concussions. Dr. Summer Ott discusses some of the options available and who they best fit.
Doctor Angie Curtis, MD, MPT fits into the Minority Women Doctors category but has a unique path.
Her original plan was to be a doctor.
Obstacles arose and she chose Physical Therapy school.
Before she could get established as a PT she knew she needed to go after her dream of becoming a Sports Medicine Doctor.
Challenges facing Minority Women Doctors
Doctor Curtis did not present on becoming a doctor as an African American woman. But a previous conversation in the hallway sparked an interest in me to learn more and help grow to understand.
I know I have preset judgments and biases based on where and how I was raised.
I also know that I am responsible for my actions and choices. I can not blame anyone else for the way I view or treat others.
Have you judged Minority Women Doctors too soon?
Dr. Curtis has been overlooked and ignored because she is a black female, dressed like a doctor, carrying clipboard and stethoscope. The nurse in scrubs was a male so he was obviously more “doctorly”
She has not allowed this to make her bitter but continues to grow and improve patient care and open doors for the women behind her.
Ever wondered how to explain the rotator cuff as a secondary stabilizer in the GH joint to either your athlete or their family? Dr. Simonich has the perfect analogy.
He tells his patients that it is like if I were to take a big exercise ball in my right arm and pull it into my chest. My chest would be the socket, the exercise ball my humeral head, my arm would be the rotator cuff and my hand the tendons of the cuff. That demonstration can help show how difficult it is for the rotator cuff to stabilize the joint.
What are the two types of shoulder dislocations, where do you see them and how should we treat them?
TUBS (Traumatic Unilateral Bankart Surgical) and AMBRI (atraumatic multidirectional bilateral rehab rarely inferior capsular shift) are the two types of dislocations.
You will see TUBS is most often in contact or collision sports like football or rugby. AMBRI is seen often in swimmers especially at the end of a long season.
Post a TUBS dislocation and relocation Dr. Simonich likes to use the apprehension test as an indicator of further treatment. He also uses athlete age (young athletes have a high rate of recurrence) individual goals, sport played and level of participation as indicators for surgery. Surgery reduces the high rate of recurrence in young athletes.
What are the types of AC joint separation and how do you treat them?
AC joint separations are relatively easy to see and cause biplanar instability. There are 5 types with Type I and II requiring conservative treatment, Type III going either way but trending non-operatively and Type IV V VI requiring reconstruction with a joint tie-down.
Clavicle fracture treatments have changed throughout the years due to research. What does the current research say?
Prior to 06’-07’ most clavicle fractures were treated non operatively. Research was introduced in two studies in those years that saw a better union rate with fixation in the clavicle post-fracture and surgeons began to surgically treat and fixate.
In 2017 a new study showed that while the rate of union is still higher in clavicle fractures with fixation, fixation doesn’t improve shoulder function nor does it decrease limitations in the shoulder. Dr. Simonich will put a plate to fixate the clavicle on an athlete with shortening, displacement, or comminution because they get faster healing rates, are more predictable and can get them back to their sports.
Watch the Athletic Shoulder 2019 presentation on Facebook
Thrower’s elbow is an injury that AT’s and coaches deal with frequently. What do we need to know as we interact with young throwers?
The more you throw and the higher velocity you throw at increases your risk for injuries. As AT’s and coaches, we need to not only be aware of the rules that are in place to protect these young athletes we need to follow them and encourage parents who may have their kids participating in multiple leagues to stay within the guidelines. The bottom line is the AMOUNT MATTERS.
What should we do when a throwing athlete begins to complain about pain?
When complaints begin we need to take them out. Shut them down from throwing and begin evaluating what might be going on. Remember that in developing youth, growth plates are the weakest link. Rest when the pain starts to prevent an injury in the growth plate.
We hear about the dreaded curveball and why it shouldn’t be thrown by young athletes. Is this accurate?
We need to change how we think about the curveball. Any speed off-speed pitch will decrease the forces on the elbow and shoulder. The more you throw at an increased speed the higher your risk moves. It’s not the curveball that is the problem, it is the fact that most young people don’t have the correct mechanics to throw it.
What about asymmetry? We are told to expect it in throwing athletes. At what point should we be concerned?
When you see a greater than 15-20 degree difference between the throwing and non-throwing hand there is a significant increase risk of injury.
If the athlete has this significant difference but isn’t experiencing pain or throwing mechanics haven’t changed, you don’t have to shut them down but you should be working to get them around 10 degrees of motion between their throwing and non-throwing arms. It’s also important to remember that throwing slows down progress on the range of motion games.
Should we change our thinking on surgical vs non-surgical treatment of shoulder injuries and thrower's elbow?
It really is a case by case basis. Young athletes with acute large tears probably should get a surgical consult. More chronic injuries in a little bit older throwers might choose rest to get them pain-free or to finish out their career. It’s not cut and dry one way or the other but needs to be evaluated case by case.
What are the biggest barriers to recovery post-injury?
The number one barrier is compliance with treatment. Staying on top of them and encouraging them to continue with the rehabilitation even once they’ve become pain-free. Compliance with prevention is also difficult. They need constant reminders and encouragement to follow through.
Are there any prehab thoughts from athletes awaiting UCL repairs?
Braces that prevent valgus and restrict 10-100 degrees are recommended. Controlling pain and inflammation pre-surgery and reducing the stiffness in the joint is helpful. The athlete can continue to exercise if they are pain-free and using symptoms as their guide.
Is there anything else AT’s should know regarding throwing injuries?
Young kids are at increased risk because of their growth plates and mechanics. Be their advocate, and follow the rules.
Ever wondered if every athlete should get an EKG? Or if caffeine is really as bad for the heart as you thought?
Today on the podcast, Dr. Mark Knoblauch sits down with pediatric cardiologist Dr. Elizabeth Wang and talks about any other information surrounding pediatric cardiology.
Dr. Wang is a born and raised Texas girl who did her undergrad at Texas A&M and got her medical degree from The University of North Texas. She did her pediatric residency and fellowship at UT Houston and is still there today.
Dr. Wang enjoys Pediatric Cardiology and refers to herself and others in this field as glorified electricians and plumbers. She is particularly interested in the athletic population because of the physiologic response to exercise.
When should an athlete see a pediatric cardiologist?
If there is no family history and the athlete is otherwise healthy and not reporting any symptoms then I educate them to remain hydrated drinking at least ½ their body weight in water per day and more if they are exercising, I encourage them to get 9-11 hours of sleep per night and to eat well including vegetables.
If symptoms are present, (ie deep pressure in chest, dizziness, passing out or palpitations) or symptoms appear or worsen with exertion then I recommend parents seek out a pediatric cardiologist.
Pediatricians and other general practitioners are vital in finding and referring abnormalities. Good physical examinations along with screening for hypertension and other abnormalities help differentiate who needs a referral to a pediatric cardiologist.
Are there drinks and other substances you recommend athletes avoid to help their hearts?
Dr. Wang absolutely recommends that athletes avoid caffeine, energy drinks, vape pens and other drugs. “If I go out of business because everyone stopped drinking caffeine and vaping then I am okay with that and I have done my job!” An otherwise-normal heart can go into arrhythmia with substances found in drugs and/or caffeine, so Dr. Wang recommends all her patients stay away from these and get more sleep.
What is your response to the thought that every athlete should get an EKG especially since there is a study sighting that Italy requires it?
Dr. Wang explains the particular study stating this is out of a small region in Italy that is very homogenous. This doesn’t apply to the US which is a large and very diverse population. EKG’s are a valuable tool but it doesn’t catch everything. There are false positives on EKG’s that can cause immense stress and thousands of dollars of follow up tests that eventually show a healthy heart, and there are normal EKG’s that aren’t followed up with the right questions about symptoms and exertional symptoms that can have a problem. There are rare abnormalities that don’t show up on a routine EKG and require a very well trained eye on an echocardiogram to diagnose. EKG’s are useful but we need to follow the guidelines for what does and does not require more testing.
If an AT suspects a cardiac issue and is worried about oxygen saturation is it best to check the lips and nail beds for capillary refill?
Dr. Wang believes that best practice is to check the gums and the tongue instead of the lips and nail beds. She explains that if an athlete is panicked or worried it can stimulate the parasympathetic nervous system and that can produce the blue lips or decreased capillary refill. “The gums and the tongue are most indicative of what your central oxygen saturation is.
Are there any closing thoughts you’d like to share?
“Please don’t be a stranger. I love interactions so please get a hold of me if you have any questions.” You can email Dr. Wang at Elizabeth.W.Wang@uth.tmc.edu
One of the huge tips she continued to share was REFER ANYTHING YOU REDUCE!!!
I have reduced injuries before and since meeting Dr. Teunis I always refer them to get an x-ray before allowing them to return to play.
Mallet Finger:
What is it: Extensor tendon rupture or avulsion involving DP joint.
Treatment– Splint religiously! 6-10 weeks
Alumaform vs. Stax Splint- Not all 1 size fits all. consult with your local hand doctor to see what they prefer and why. discuss ways to ensure patient compliance and seamless transition from office to AT Facility.
NOT ALL Mallet Fingers can be splinted, some require surgical intervention.
Jersey Finger-
What is it – Flexed finger pulled into extension (commonly ring finger, 75%) rupturing flexor tendon.
Treatment:
Dislocations
Dorsal Dislocation- splint 1 week, then buddy tape
Volar dislocation – much less common, extensor mechanism disruption, hard to reduce
Mimickers-
Traumatic Boutonniere
Skiers Thumb
Scaphoid Fractures
Hard to treat
hard to diagnose.
Common in football – “see these in December”
Scaphoid fractures…about 40% are missed and that is bad news, they take several months to heal due to poor blood flow. if it dies you get arthritis in your 20s.
Fall on outreached hand (FOOSH)
Need more on Care for the Active Wrist?
Live from Memorial Hermann's Sports Medicine Update 2019 Dr. Teunis lectures on Can't-Miss Injuries of the Hand and you can see that presentation here on Facebook
After graduating magna cum laude with his Bachelor of Science in Biochemistry from the University of Houston, Dr. Benedict Ifedi received his medical degree from Baylor College of Medicine in Houston. He went on to complete his family medicine residency at Memorial Family Medicine Residency in Sugar Land, Texas, where he also served as chief resident. Afterwards he completed a fellowship in sports medicine at Bayfront Health in St. Petersburg, Florida.
Board certified in family medicine and sports medicine, Dr. Ifedi treats patients ages 5 and older. He provides care for sports-related injuries, such as strains, pulls and concussions, as well as wellness and preventive medicine. His clinical interests include management of chronic diseases, exercise medicine and physical activity.
He is an active member of the American Academy of Family Physicians, American Medical Society for Sports Medicine, and American College of Sports Medicine. Patients in Katy and the surrounding communities enjoy his welcoming smile and genuine concern for their well-being. Dr. Ifedi’s goal is to help his patients get back to feeling their best and to help teach them the best methods to achieve optimal health.
In his spare time, he enjoys traveling as well as watching and playing sports.
Call to Action:
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Summer was packed with learning for me with 3 Sports Medicine conferences, and 1 podcast conference. I have learned a lot of things but that for the most part we are on the right track. We continue to improve by learning each week from the podcast, and I am working on continually improving the podcast for you.
Thanks for being part of the show Israel and Mickey.
We are broadcasting live and interviewing the speakers of the Memorial Hermann's Sports Medicine Update. Some of the recordings pick up noise, but this is a live event.
We plan to release the lecture and then the interview. Through the course of the summer the podcasts will be shorter, more frequent, and a lot more raw (less editing).
All the lectures and handouts have been uploaded and are now available on Google Drive. Go to www.drive.google.com and sign-in using the following:
Username: sportsmedupdate2015@gmail.com
Password: sportsmed
Once the school year resumes we will return to our regular format.
Also be sure you are signed up for the SMB Email List as there will be codes and prizes given out from that list for our partnership with SchoolHealth.com
We are broadcasting live and interviewing the speakers of the Memorial Hermann's Sports Medicine Update. Some of the recordings pick up noise, but this is a live event.
We plan to release the lecture and then the interview. Through the course of the summer the podcasts will be shorter, more frequent, and a lot more raw (less editing).
All the lectures and handouts have been uploaded and are now available on Google Drive.
Go to www.drive.google.com and sign-in using the following:
Username: sportsmedupdate2015@gmail.com
Password: sportsmed
Once the school year resumes we will return to our regular format.
Also be sure you are signed up for the SMB Email List as there will be codes and prizes given out from that list for our partnership with SchoolHealth.com
