Wednesday, December 19, 2012


A concussion is an injury to the brain that commonly occurs in sports. There are an estimated three to four million sport-related concussions that occur in athletes each year. Concussions can occur from a direct blow to the head or a blow to somewhere else on the body that produces a jerking motion of the head. Most concussions do not result in being knocked out or losing consciousness.

Common symptoms of a concussion include headache, fatigue, dizziness, confusion, sensitivity to bright lights or loud sounds, difficulty with concentration or memory, feeling sick to your stomach and emesis (throwing up). Athletes may experience one or more symptoms. If an athlete experiences any of these symptoms after a head injury, it should be assumed that the athlete has had a concussion.

An athlete who sustains a concussion should not be allowed to return to play or resume activity on the day of their concussion. An athlete should not return to sports until evaluated by a medical professional who is experienced in concussion management, and determines the athlete to be free of symptoms both at rest and with activity. An athlete who is still having symptoms has not cleared their concussion.

To learn about the treatment of concussions, click here for additional information.

Monday, December 17, 2012

Learn more about ACL Injuries from Dr. Rick Wright

Learn more about ACL injuries from Rick Wright, MD. Fellowship trained in sports medicine in Minneapolis, where he participated in the care of professional and collegiate team care, Dr. Wright has a strong interest in athletic team coverage and serves as the head team physician for the St. Louis Blues, and team physician for the St. Louis Rams.

Tuesday, December 11, 2012

High Ankle Sprains

Learn more about high ankle sprains from Matthew Matava, MD, an orthopedic surgeon at Washington University Orthopedics in St. Louis, Missouri.

Wednesday, November 14, 2012

Pediatric Orthopedic Hip Conditions and Treatment

Visit the patient education section on our website to learn more about pediatric orthopedic hip conditions and treatments. Click here for more information.  

Monday, November 12, 2012

Knee Pain in Children

Knee pain is most likely to develop in children who participate in sports involving jumping and running, such as basketball and volleyball. Learn more about knee pain in children. Watch the video here.

Thursday, October 11, 2012

Ask Dr. McCormick

Question:  “I sprained my ankle last spring while I was running.  The ankle doesn’t really hurt anymore, but it keeps ‘giving out’.  What should I do?”

Answer:  Ankle sprains are the most common foot and ankle injury in sports.  Typically, sprains occur when the foot inverts with an awkward step while running or jumping.  As the foot rotates inward, the ligaments on the outside, or lateral aspect of the ankle, are stretched, causing swelling and pain.  Most frequently, sprains will recover completely with rest, ice, compression, elevation and early mobilization.
In less than 10% of cases, while ankle swelling and pain improves, the ankle continues to “give out” or feel unstable.  Classically, this occurs when walking on uneven ground or when stepping off of a curb.  Repeated episodes of “giving out” is a condition called chronic ankle instability.  Most frequently, this is a result of incomplete recovery from an acute ankle sprain that leaves the ankle with weakness and impaired postural control.
The initial treatment for chronic ankle instability is a program of structured rehabilitation with the help of a physical therapist.  Exercises are aimed specifically at strengthening the peroneal tendons which run on the outside aspect of the ankle.  The regimen should also include use of a balance board or similar device to work on proprioception – awareness of the position of the foot and ankle in space.  Improved proprioception helps the ankle react more quickly to stresses, preventing future sprains.
After 6-8 weeks of intensive therapy, if the ankle continues to feel unstable, one might be a candidate for surgery to reconstruct the injured ankle ligaments.  At this point, an MRI is helpful to identify any underlying injury such as cartilage damage at the ankle or peroneal tendon tears.  Complete recovery from surgery takes at least 3 months, but patients will typically be able to return to full activity without limitation, and, most importantly, without the sensation of their ankle “giving out”.

Wednesday, October 10, 2012

Ask Dr. Klein

I have bunions, but my feet don't hurt. My sister says that I should have them fixed before they become worse. Is this true?

Many people have bunions, but not all bunions are painful. A bunion is more than a "bump" on the side of your foot. It is a deformity of the great toe that frequently runs in families. If bunions run in your family, you may be predisposed to developing a bunion over time. Bunions range from mild to severe and are most common in populations of people who wear shoes.

In fact, shoe wear plays a significant role in the development of a bunion deformity. Bunions can worsen over time and become painful if your shoes are not an adequate width for your foot. High-heeled shoes also influence the development of a bunion by increasing pressure on the forefoot. As bunions become worse, they can become painful or the lesser toes can become painful.
Many bunions do not become painful or change over time. With appropriate shoes, bunions can remain stable and may not limit your activity level. The primary indication for surgical treatment of a bunion is pain. If you are having pain that limits your ability to wear most shoes and limits your activities, you may consider surgical correction of your bunion. If you are not having pain, there is no reason to correct a bunion today due to concerns that it may become worse in the future.

Surgical treatment for bunions usually involves an osteotomy, or a cut in a bone to realign the great toe. Sometimes multiple osteotomies are necessary to correct the deformity. The surgical treatment depends on the
specific deformity causing the bunion and may vary from person to person. If hammertoe deformities of the lesser toes develop, these are often corrected at the same time. If you have foot pain related to a bunion, an orthopedic foot and ankle surgeon can provide you with a surgical evaluation.

Monday, September 24, 2012

Ryan Calfee, MD, discusses thumb injuries

Learn more about thumb injuries from Ryan Calfee, MD, an orthopedic surgeon at the Washington University Orthopedics Peterson Hand Center in St. Louis, Missouri.

Friday, September 21, 2012

Washington University Orthopedics Peterson Hand Center

The Washington University Peterson Hand Center was featured on the cover of Ladue News today (September 21, 2012).

With a number of talented hand and wrist specialists coalescing at Washington University Orthopedics, forming the Peterson Hand Center was an obvious next step. “We really do have a group that offers one-stop shopping,” says co-chief of service Dr. Martin Boyer. “There’s really nothing in the hand, wrist and upper extremities that we don’t do: everything from carpal tunnel release to transplantation of bone and microsurgery to restore circulation, and also transplantation of toes to restore hand function. The patient can be fairly certain that whatever their hand or wrist problem, we have the expertise.”

That expertise is important to patients, whether they’re suffering from a common ailment like carpal tunnel, or from something rarer such as a child born with birth abnormalities, adds co-chief of service Dr. Charles Goldfarb. “This is what we do; we don’t dabble in hand surgery. We have committed our professional lives to patient care and enhancing the field of hand surgery, working with the science and moving it forward.”
  Read the entire story

Thursday, September 6, 2012

Meet Dan Osei, MD

Dan Osei, MD, is the newest member of the Washington University Orthopedics Peterson Hand Center!  Learn more about Dr. Osei!

Other Washington University Orthopedics Peterson Hand Center physicians include Martin Boyer, MD; Ryan Calfee, MD; Richard Gelberman, MD; Charles Goldfarb, MD; and Lindley Wall, MD.

Thursday, August 30, 2012

Older athletes face greater chance of injury, but risks are worth it

Watch the KSDK news segment here to learn more about how older athletes face a greater change of injury.  Matt Matava, MD, a Washington University Orthopedics Sports Medicine Surgeon, is interviewed for this segment.

Monday, August 6, 2012

Learn more about Rotator Cuff Tears

For 20 years, Illinois resident Don D’Agostino suffered from an increasingly painful shoulder injury. A Senior Master Sergeant in the U.S. Air Force, D’Agostino was stationed in West Germany in 1984 and remembers the day the pain started. “I was throwing camouflage netting up and over my head and I wrenched my left shoulder,” he recalls. “For years, my shoulder would ache, but it got to the point eight years ago when I just couldn’t even lie down and sleep on that side. I said to myself that enough was enough.”

D’Agostino went to his physician and was diagnosed with a torn rotator cuff. Don, one of an estimated 13 million people in the United States who seek medical care for shoulder problems each year, tried physical therapy, anti-inflammatory drugs, and over-the-counter and prescription painkillers. Offering little relief, D’Agostino eventually turned to the shoulder experts with Washington University Orthopedics.
“Shoulder injuries are fairly common. The shoulder is characterized by a fine balance between mobility and stability that is maintained by a series of muscles, ligaments and tendons which allow for a wide range of movement,” says Leesa Galatz, MD, shoulder surgeon with Washington University Orthopedics and D’Agostino’s shoulder specialist. “The rotator cuff is composed of four muscles that surround the shoulder joint. They can be torn either through repetitive use over time or because of a traumatic injury. The incidence of these types of tears increases with age and can be present in both shoulders even though a patient feels pain only in one joint.”

Tuesday, July 24, 2012

Our doctors named to Best Doctors in America List

We are very fortunate to have so many of our Washington University Orthopedics doctors named to Best Doctors in America list for 2012! Read here to see if your doctor made it:

Your Questions answered by Dr. Brophy and Dr. Halstead


Approximately how many stitches do the Blues receive each year?We typically will have to stitch up a cut approximately every other game and the cuts are usually ¼ to 1 inch long and require 4 to 5 stitches per cut. Approximately 15 to 20 lacerations require suturing each year.

It’s well known that professional athletes must engage in strength and aerobic training in order to perform at their level of play. How much stretching is involved in their training routine and what’s the latest recommendations regarding stretching?Many of the Blues players like most athletes do some forms of stretching. Recently, over the last several years some controversy has arisen regarding how much stretching is appropriate, but most do upper and lower body stretching prior to practice and games.

What is the best cardio exercise to do in the presence of hip bursitis?Almost any form of cardio exercise in the presence of hip bursitis would aggravate it. This would include elliptical, treadmill, StairMaster, running and walking. Cycling probably would also aggravate hip bursitis. Swimming may be the least aggravating. It would be better to treat the hip bursitis which would then allow you to follow any cardiovascular exercise program that you desire.

How do you determine the severity of a concussion? What causes a player to be out so long in instances like David Perron is facing?Severity of a concussion is determined by a variety of signs and symptoms based on symptoms such as loss of consciousness, headaches, fatigue, visual and other sensory changes. The severity of a concussion is difficult to ascertain at the time of injury and what may be seemingly moderate injuries may result in long-term symptoms or more severe injuries may result in relatively quick resolution. This is what makes concussion treatment so difficult. It is hard to predict symptomatology and duration.

What path did you take that led you to become a Blues team physician? Following four years of undergraduate work and four years of medical school, I pursued an orthopaedic surgery residency that lasted five years. Following my orthopaedic surgery residency I did a sports medicine fellowship for subspecialty training in sports medicine at the Minneapolis Sports Medicine Center. During that time I had exposure to coverage of the professional teams in Minneapolis which helped prepare me for the opportunity that arose in our third year of practice when our group was asked to take over the care of the St. Louis Blues Hockey team.

Thursday, July 19, 2012

Telling the Difference between an Ankle Sprain and an Ankle Break

Steps to differentiating between a sprain and a break:
1. First, ask the injured person how they became injured. If a cracking noise was involved, this is most likely the sign of a break. However, a tearing or poping noise is more likely to be a sprain.
2. Next, look at the joint. If there is swelling and if the joint looks crooked or lumpy, this could signal a break.
3. Ask if the person has numbness, as this is a sign of a break.
4. Inquire about the severity of the pain. Severe pain is more closely associated with a break whereas discomfort is more associated with a sprain.
5. Then, have the person move the joint. If the ankle is extremely painful, but is still able to move, this is most likely a sprain. However, if the ankle cannot move at all, it is a break.
6. Try applying weight to the joint. If you cannot apply any weight, the ankle is broken.
7. Finally, have the ankle x-rayed by a doctor to double check that you do not have any fractures in bones in the the foot.

Wednesday, July 18, 2012

FAQ about Sports Medicine

Are there any excercises that can be done to reduce the risk of a knee injury (especially the ACL)?ACL injury prevention programs are currently being studied. It appears that prevention programs can decrease the risk of injury by 50% or more. Currently there is no consensus on the best exercises to perform, but it appears 10 minutes of neuromuscular training at least 3 times a week will decrease injury risk. Further research is necessary to determine the exact amount and type of exercise that is most effective.

Can you do anything to help relieve the pain from a puck bruise?Pain from a puck bruise is best treated by ice, decreased activity and elevation to decrease swelling. The player can return to play as weight bearing and skating pain allows. Depending on the severity of the bone bruise from a puck injury, it can last from a matter of just a few days to two to three weeks.

What is the most common sports-related injury in hockey and what can be done to reduce this injury?
One of the most common injuries is groin adductor strains. These are common in forwards, defensemen and goalies. They cannot be completely prevented, but it helps to avoid them with proper warm up and stretching. Maintaining good quadriceps, hamstring, adductor and hip abductor strength balance is also beneficial.

What is the difference between and ACL and MCL?
The ACL and the MCL are two ligaments of the knee. The MCL is the medial collateral ligament and it resides on the inside of the knee and gives side-to-side stability during knee function. It is frequently torn in athletic activities especially contact injuries where a blow to the outside of the knee can cause a tear of the medial collateral ligament. It heals without surgery and typically requires only bracing and therapy to allow return to play once it is healed.

The ACL or anterior cruciate ligament resides in the middle of the knee and gives stability during cutting, twisting, jumping and change of direction activities. It can be torn in a contact or non-contact situation and once it is torn, it does not heal. For patients that desire to return to their previous activities that may have required an ACL, they must undergo surgery to replace the ACL which we call an ACL reconstruction. This typically involves replacing the ACL with part of a hamstring tendon or part of a patellar tendon. After a six month rehabilitation and recovery, you can return to your sporting activities.

To learn more about our Sports Medicine department head to our website at:

Monday, July 16, 2012

Sports Medicine Update 2012

This Friday and Saturday we are hosting our annual Sports Medicine Update in downtown St. Louis. The conference features both our faculty and guest faculty from around the country. Dr. Halstead is the Course Chairman and Dr. Smith, Dr. Brophy and Dr. Clohisy will also be leading lectures on their various specialties. We will also have guest faculty from Children's Hospital of Wisconsin, St. Luke's Physical Therapy, Vanderbilt School of Medicine and Rocky Mountain Hospital for Children speak at the conference. Check out our live tweets @wustlortho

Learn more about our sports medicine update here at:

Tuesday, July 10, 2012

Meniscus Tear Overview

Dr. Matava discusses meniscus tears:

Head to our main page to learn more about our sports medicine program:

Monday, July 9, 2012

Hirsch Twins Story of ACL Reconstruction

patient fully recovered from ACL Reconstruction of the kneeThey may play different sports, but the Hirsch twins are, indeed, mirrors of each other. Active in basketball, softball and soccer for much of their childhood, Jennifer and Alayna Hirsch have undergone knee surgeries to treat ligament tears. Now, after some well-spent time helping each other recover and prepare for active sports seasons, both are in their senior year at Millikin University in Decatur, IL.
“We were anxious to play sports in our last year at college,” says Alayna. “I think we both worked hard to keep up with physical therapy and strengthening exercises so that we would be in good shape for the upcoming coming season.”
Alayna was the first to undergo surgery to reconstruct a torn anterior cruciate ligament (ACL) in her left knee that occurred while playing basketball at Parkway North High School in January, 2001. “I was a freshman point guard for the women’s basketball team and it was the end of a game when I went up for a lay-up. When I landed, I hyper-extended my knee and felt a pop,” says Alayna. “It was a very sharp pain. I let it rest for a couple of weeks and then tried to play in another game, but my knee gave out during warm-ups. My athletic trainer took one look and said I probably tore my ACL.”
The ACL is one of four major ligaments that stabilize the knee. In active individuals, especially those playing sports with rapid changes in direction such as soccer, baseball, hockey, football, or skiing, an ACL tear is one of the most common significant injuries to the knee.
“Once an ACL is torn, it cannot heal or repair itself,” says Rick Wright, MD, co-chief of sports medicine service with Washington University Orthopedics and team physician for the St. Louis Blues and St. Louis Rams. “We can improve range of motion and mobility with muscle-strengthening exercises to a small extent, but reconstructive surgery is the best option for those who want to regain an active lifestyle.”
Torn ACLs are reconstructed by taking strong, healthy tissue from either the patient’s patellar tendon (a strip of tendon underneath the kneecap) or a hamstring and surgically attaching the graft to the thighbone and shinbone. Donated cadaver tendons also can be used. The procedure restores stability.
Alayna underwent several months of physical therapy to get back in shape again to play high school sports. In a strange twist of fate, her sister Jennifer suffered the same injury and underwent ACL reconstruction later that fall.
“I was playing softball and twisted suddenly while throwing the ball in from the outfield,” she recalls. “I knew immediately that something was wrong.”
After four to six months of physical therapy, Jennifer also went back to an active schedule of high school sports. Both girls were later recruited by Milliken University to play multiple sports.
Fast forward to 2007. In what looked like a repeat of their earlier injuries, the Hirsch twins were again playing their favorite sports at Millikin — Jennifer playing soccer and Alayna on the softball team — when each tore the ACL in their opposite knees within two months of each other.
“Unfortunately, it’s not surprising that they injured their other knees,” says Dr. Wright, who has specialized in ACL reconstruction and other knee procedures for more than 13 years. “Research has shown that the opposite normal knee is just as likely to rupture after ACL reconstruction of the first knee. And women seem to be more prone to ACL tears than men.”
Dr. Wright is a principal investigator in the MultiCenter Orthopaedic Outcome Network (MOON) for ACL reconstruction. For the past several years, a national network of orthopedic surgeons in nine medical centers has been tracking ACL reconstruction patients to determine what risk factors lead to the development of a second ACL tear or the onset of osteoarthritis or decreased mobility in either knee. Investigators are also closely evaluating the differences in male and female anatomy to see how gender plays a role in the potential for ACL injuries.
“By following a large number of ACL patients in all of the medical centers involved, we hope to identify the variables that enable us to predict which patients are more likely to develop future injuries,” says Dr. Wright. “We can then evaluate treatment and therapy options to try to prevent those secondary injuries from occurring.”
Both Jennifer and Alayna Hirsch are enrolled in the MOON study and will be evaluated over the next 10 years to see how they continue to recover from their dual ACL reconstructions. For now, each is looking forward to an exciting senior year of sports at Millikin University and completing requirements for degrees in physical education and sports fitness.
“There’s always a little angst as I watch them get ready to play soccer or softball,” says the girls’ mom, Nancy. But they’re excited about their senior year and I’m glad to know that they are working on strengthening their legs and getting in shape again. “Playing sports is their passion and we’ve been fortunate to find great medical care for both of them.”

Thursday, July 5, 2012

Step into Summer

Summer is here with warm weather, outdoor activities and our favorite summer shoes.  Frequently, foot pain or problems with the feet are a direct result of the shoes that we choose, so these are a couple of tips to keep your feet safe in the summer:
·         The warm summer weather often encourages us to participate in new activities.  While outdoor athletic activities are a healthy pursuit, be careful when starting something new.  You should make sure that the shoes that you wear are appropriate for the particular sport or activity.  Overuse injuries are frequently seen in the foot and ankle when you try to do too much of one activity after a long winter.  Start slowly and increase your activity as you become stronger and your endurance increases.
·         Flip-flops rule at the pool!  Many patients ask whether flip-flops are safe to wear, and the answer is “yes and no”.  When protecting your feet from hot pavement at poolside, flip-flops are an excellent choice.  Flip-flops can actually help strengthen feet and are best worn on flat reliable surfaces.  When you head to the local amusement park for a day of walking or to the closest state park for an outdoor hike, leave the flip-flops at home.  Long periods of walking and extensive walking on uneven ground with flip-flops or any open back sandal can cause injury to the foot.
·         Stylish sandals and summertime shoes for men can offer minimal support and risk injury to the foot and ankle when worn for inappropriate activities.  While there is no harm to wearing these shoes to a casual barbeque or dinner party, you may cause injury to your foot if you decide to hop on a bike or participate in the unexpected softball game in this type of shoe.  Wearing your favorite summer dress shoes should be limited to activities that require a very low level of activity.
In summary, choose the shoe to match the activity.  Keep a pair of supportive athletic shoes and socks in the car so that you are ready for anything and have a great summer!
By: Sandra Klein, MD

Monday, July 2, 2012

Common Sports Medicine Injuries

Shin Splint is a condition resulting from extreme physical activities and exercise that bring about muscle fatigue thereby resulting to the application of extra force to the tissue connecting muscles to shinbone. This can be treated through proper rest and refraining from any kind of exercise and physical activities. However, if the pain persists, surgery may be needed depending on the recommendation of the Sports Medicine Physician.
Rotator Cuff Tear is a kind of injury on the muscle shoulder as a result of repetitive motion or traumatic impact. Depending on the severity of the injury, this can be treated through non-surgical or surgical method.
Achilles Tendon is considered as the biggest tendon in the body connecting the muscle at the lower back leg and the heel bone. When over stretched, a tear may occur resulting to severe pain accompanied by swelling. If the tendon is severely damaged, surgery is the only cure.
Torn Meniscus is a cartilage found between the shin bone and thigh bone. The cause of the tearing of the meniscus is brought about by excessive stress on knee joint from over rotation, prolonged squatting or traumatic collision. Non-surgical treatment like compression can be applied.

Thursday, June 28, 2012

Frequently asked questions about scoliosis

Why does scoliosis develop most often in late childhood?
And why is it more common in girls? Scoliosis most often develops in late childhood because of the association between growth and progressive scoliosis curves. Although scoliosis can develop at any age, including infantile (age birth- 3), Juvenile (age 3-10), adolescent (age 10-18) and adult (> age 18), the most common time to detect curves are in late childhood/early teen years. Thus, the most common form seen, Adolescent Idiopathic Scoliosis (AIS), is detected between ages 10 and 18, often just before or after puberty and the associated adolescent growth spurt. Small curves (10-20 degrees) are nearly equally found in boys and girls, but larger curves which often need treatment (those > 40 degrees) are seen in females to males in a 9:1 ratio. It is a bit unclear why that is the case, it may certainly be a genetic tendency, and/or something relating to hormonal alterations or connective tissue adaptations for the potential for childbirth in females.
What causes some children to develop scoliosis while others do not?
Is it simply genetic or are there other factors involved? Although there are many potential etiologic factors implicated for idiopathic scoliosis development, the genetic aspects are probably the most influential. Multiple genetic studies have confirmed strong family relations including studies of identical vs paternal twins. Other factors such as various hormones, equilibrium and balance issues have been promoted as well, but none are conclusive. The genetic factors are strong but highly complex, multigene interactions that are still being actively investigated, including here at Washington University by Dr Matt Dobbs of the Department of Orthopedic Surgery.
What causes adults to develop scoliosis?
Adults can develop scoliosis as a result of slow progression of childhood curves that were untreated, or as curves that develop on their own from aging of the spine, usually in the lower (lumbar) region and termed "de novo" adult lumbar scoliosis. These de novo curves result from progressive degeneration of the joints in the back of the spine along with degeneration of the discs supporting the front of the spine. Although this natural aging process occurs in everyone, only certain people will develop a corresponding scoliosis with the process.
At what point is a brace needed to treat scoliosis?
Bracing is indicated only for children and teens that are still growing in order to attempt to slow or stop the scoliosis progression during the remainder of the child's skeletal growth. It is also only indicated for mild to moderate curves in the 20-40 degree range and appears less effective in males and those with larger body habituses.
Beyond bracing, what are the treatment options? Are minimally invasive procedures becoming more common?
There are 3 standard treatments for scoliosis in Children: Observation, Bracing (as above) and surgery. Observation is indicated for small curves (< 20 deg, no matter what the age), and curves < 45-50 degrees in those who are skeletally mature. Surgery is indicated for curves > 40-45 degrees in those with growth remaining, and >45-50 degrees for those who are done growing (skeletally mature). For adult patients, there is really no good indication for bracing except for the rare circumstance of helping patients with lumbar pain, postural changes for temporary pain relief. Observation with physical therapy, aerobic activities etc are indicated for a vast majority of patients with smaller curves and minimal symptoms. Active non-surgical treatment such as epidural steroid or nerve root injections are indicated in the subset of adults who have spinal stenosis (narrowed spinal canal) and/or pinched nerves in the lumbar spine. Surgery is reserved for those adults with previously untreated adolescent scoliosis with continued curve progression in adulthood to curves > 50-60 degrees in the thoracic or lumbar spine, or for those denovo curves > 30-40 degrees in the lumbar spine in which the patient is symptomatic.
Can scoliosis cause related problems with blood flow or organ systems?
Scoliosis can cause restricted pulmonary disease when affecting the thoracic spine, and even suboptimal cardiac function in the very severe curves > 90-100 degrees. For curves affecting the lumbar spine, spinal stenosis and/or pinched nerves can cause lower extremity pain/disability. Also, for those patients whose spine is collapsing, the trunk can shorten with the rib cage resting on the pelvis making breathing more difficult and often impairing GI function as well. Also, the psychosocial aspects of living with a progressive disfiguring spinal deformity cannot be ignored and impaired quality of life parameters are documented in the literature for various subsets of adult scoliosis patients.

Friday, June 22, 2012

Physiatry 'Missing Link' in Orthopedics

In her office at the new Washington University Orthopedics and Barnes-Jewish Hospital Outpatient Orthopedic Center in Chesterfield, Heidi Prather, D.O., first lowers her eyes, then looks at the ceiling for a moment as she recalls her decision to go into physical medicine and rehabilitation as a specialty and to focus a part of her practice primarily on women.
“I’ve never told this story,” she says. “My mentor during residency, who happened to be male, once looked at me and said, ‘Since you’re going into academic medicine, you’d better figure out these things about women because we men aren’t going to.’ That’s honestly when I thought, ‘OK, that can be my issue.’”
That was during her residency at the Rehabilitation Institute of Chicago, which is home to the Northwestern University Feinberg School of Medicine’s Department of Physical Medicine and Rehabilitation. Her mentor, Joel M. Press, M.D., says he was mostly telling her things she already knew.
“She always understood that it’s about the patient,” says Press, director of the Rehabilitation Institute’s Spine and Sports Rehabilitation Center in Chicago. “By focusing on patient needs, both women and men, she’s become a leader in our field. She’s also been able to build one of the best musculoskeletal fellowship programs around and helped improve the already outstanding reputation of Washington University Orthopedics.”
Prather, an associate professor of physical medicine and rehabilitation, is the first woman president of the Physiatric Association of Spine, Sports and Occupational Rehabilitation. In that capacity, she’s getting a chance to raise awareness nationally among physiatrists (those who specialize in physical medicine and rehabilitation) regarding issues involving women and injuries.
She says when treating an injured woman, doctors — and physiatrists in particular — must consider the continuum of the lifecycle for women and where the woman is along that timeline when she experiences an injury or impairment.
“There are pre-pubertal women versus post-pubertal,” she explains. “Then there’s before babies, during pregnancy, immediately post-partum, pre-menopausal, post-menopausal and aging. Where a woman is on that timeline will greatly influence her musculoskeletal function. Men simply don’t undergo the same kinds of changes.”
For example, when a pre-menopausal woman has a compression fracture of the spine, Prather immediately worries about early osteoporosis. A similar fracture in an older woman also might be due to weakened bones, but determining the cause of such a fracture — an important factor in determining treatment and rehabilitation — is especially urgent for a woman of 40.
“I might easily see what the problem is, but figuring out why a woman has the problem is key,” she says. “If I don’t learn the cause, there’s a good chance she may face that same problem in the future.”
Music and tennis
Prather herself has been happy to avoid injuries lately. Because she’s been injury-free, she’s been running quite a bit. She says she rarely exercises when injured.

Heidi Prather, D.O.  Born: May 20, 1965, Kansas City, Mo.
Education: Bachelor of arts with honors, biology and chemistry, 1987, Drury College; D.O., University of Health Sciences College of Osteopathic Medicine, 1991
University position: Associate professor of physical medicine and rehabilitation, Washington University Orthopedics
Family: Son, Ethan Bradley (10); daughter, Emma Bradley (6); husband, Jeffrey Bradley, M.D.; mother, Becky Prather; father, Carl Prather; sister, Gretchen Evans
“I don’t overdo it because when I work with my patients, I see what can happen,” she says. “I’m pretty good when I’m hurt. I rest, and then I usually go around and ask other physicians and physical therapists to look at me. I find it’s usually better to trust someone else than to try to diagnose yourself.”
She grew up in Kansas City in a family of musical tennis players. Her father, Carl Prather, was a band director. Her mom, Becky, played drums. Heidi herself took up the trumpet and attended Drury College in Springfield, Mo., on a music scholarship, playing in the symphonic band and other musical groups, including the professional symphony in Springfield. But she never wanted music to be “work,” hoping instead to use it as an outlet.
These days, she plays piano to relax after long nights of dictation. She’d like to return to music more seriously someday, but that will have to wait until her kids Ethan, 10, and Emma, 6, are a little older. Much of her spare time these days is spent as a “soccer mom,” attending games and practices and taking turns shuttling them to Tae Kwon Do and dance lessons with her husband, Jeffrey D. Bradley, M.D., associate professor of radiation oncology at the Siteman Cancer Center.
She calls herself the least talented tennis player in the family, but she still managed to compete at Drury. Her younger sister, Gretchen, was the star, however, and still competes in sanctioned tournaments, recently playing in a national event.
In addition to running, Prather also rode her bike across Missouri this summer, accompanying her mentor, Joel Press. She was with him for 213 miles of his cross-country bike trip called the Ride for Rehab. Missouri was only a small portion of his total trip, but Prather made enough of an impression to receive official recognition as the Ride for Rehab’s “top female physiatrist rider without twins.”

By: Jim Dryden

Read the original article here:
Keeping dancers on their toes | Newsroom | Washington University in St. Louis

Thursday, June 21, 2012

Spine Disorders Complicate Hip Arthroplasty

Patients undergoing total hip arthroplasty (THA) who have coexistent lumbar spine disorders (LSDs) do not report as much improvement in pain and function after arthroplasty compared with patients without lumbar disorders.

(HealthDay News) — These are the findings according to a study published in the May issue of The Spine Journal.
Heidi Prather, D.O., from the Washington University School of Medicine in St. Louis, and colleagues retrospectively examined 3,206 patients who underwent THA from 1996 to 2008. To identify which patients were also evaluated by a spine specialist, the International Classification of Diseases, Ninth Revision billing codes for LSDs were cross-referenced with patients who had undergone a THA. Functional outcomes were measured using the modified Harris Hip Score (mHHS) and University of California Los Angeles (UCLA) hip questionnaire, and physician medical charges were assessed.
The researchers found that a higher number of LSD patients were significantly older (64.5 years) compared with patients treated with THA alone (58.5 years). Compared with the THA + LSD group, patients in the THA alone group had significantly greater improvement in the mHHS, UCLA score, and pain. On average, patients in the THA + LSD group incurred significantly more in charges per episode of care ($2,668) and significantly more days per episode of care, compared to patients with THA alone.
"Patients undergoing THA alone had greater improvement in function and pain relief with fewer medical charges as compared with patients undergoing a THA and treatment for an LSD," the authors write.

Read the original article in MD News here:
MD News - Coexistent Lumbar Disorders Complicate Hip Arthroplasty

Wednesday, June 20, 2012

Spinal Tumor Recovery

Mary Martinez playing golf after spine tumor surgeryMary Martinez is back to bowling and golfing and is “doing fantastic,” though she says she’s under doctor’s orders not to lift refrigerators or break up concrete. Just one year ago, the 60-year-old Martinez was treated for lung cancer that had metastasized to her spine, and Jacob Buchowski, MD, MS, had to implant two artificial vertebrae to replace those that had been consumed by cancer.
Martinez, whose nickname at Barnes-Jewish Hospital was “the sledgehammer lady,” first learned that something was wrong when her back made an audible “pop” while she was wielding a sledgehammer to break up an old walk around her swimming pool. Excruciating pain below her shoulder blade radiated down her arm and made her left side ineffective.
Based on the advice of her chiropractor, Martinez underwent an MRI when X-rays were negative and three weeks of chiropractic treatment did nothing to relieve the pain. The scans revealed a lesion on her lung, which Martinez, a long-time smoker, says matter-of-factly didn’t surprise her. It took exploratory surgery to find the cancer’s metastasis to the spine.
Eventually, Martinez was referred to a Siteman Cancer Center oncologist, but the disease was unresponsive to chemotherapy, and surgery on both her lungs and her spine was scheduled for St. Patrick’s Day of ’08.
In a complex, day-long surgery, Buchowski and colleagues removed the entire tumor which originated in the lung and invaded two thoracic vertebrae. The extent of tumor involvement made it necessary to reconstruct the spine with a metal cage, screws, and rods.
Although the need for radiation prior to surgery made wound healing difficult and Buchowski had to schedule plastic surgery by a colleague, the problem was completely resolved. Martinez, a former Illinois special education teacher, says now that she is “not quite the Energizer Bunny,” but is grateful to be active again and lucky that the sledgehammer incident introduced her to Buchowski.
“I did my research on the Internet, and he was the right man for the job. He always made me feel very secure, and always told me the truth, including that my surgery would last about 10 hours. I’m very thankful that Dr. Buchowski could help me.”

Monday, June 18, 2012

Can acupuncture treat back pain?

Acupuncture has relatively good evidence in the literature for treatment of chronic nonspecific low back pain. Several studies show that it can work better than ususal care which includes medications or physical therapy. Interestingly, randomized controlled trials did not show acupuncture to be superior to a sham acupuncture procedure. Acupuncture treatments usually consist of weekly visits, and it may take up to 5 session before noticing a benefit. Because of the out-of-pocket expense, acupuncture is often not the first line of treatment for low back pain. Patients I treat have usually failed all other treatments. Despite this, I am still able to get some results in this difficult population. Due to its good safety profile and minimally invasive nature, I think acupuncture is a good option for anyone that wants to try a more alternative approach to low back pain.

By: Chi- Tsai Tang, MD

Read more about Dr. Tang at:

Friday, June 15, 2012

Thursday, June 14, 2012

Modern Acupuncture

The use of acupuncture was first documented more than 2000 years ago. During the 6th century, improved transportation within Asia led to Chinese medicine spreading across Asia. Today, acupuncture remains a crucial part of the Japanese and Chinese health care system, offered alongside modern medicine. Acupuncture began to gain western attention after President Nixon visited China in 1972 where he witnessed acupuncture being performed. Today in America, acupuncture has grown into a common form of pain managemnt in may clinics and hospitals. It is estimated that 15 million Americans or roughly 6 % of the American population, has visited an acupuncturist for a variety of symptoms including chronic pain, fatigue, nasea, arthritis and digestive problems. In 1995, the FDA classified acupuncture needles as medical instruments and assured their effectiveness. Then in 1997, the NIH recommended that insurance companies begin to provide full coverage for the treatment of certain conditions using acupuncture.

Dr. Tang, a physiatrist, uses medical acupuncture to treat different forms of pain.
You can request an appointment online here:

Wednesday, June 13, 2012

Medical Massage

Medical Massage is massage and/ or myofascial release that is directed to a specific injury or painful area. The patient will present with a specific diagnosis and the treatment is geared towards that diagnosis. The massage therapist will work on the fascia (connective tissue) and the muscles that they feel are contributing to the pain and dysfunction. An assessment including a postural analysis will be performed. Pain levels and function improvements are often the standard measurement for patient progress. Myofascial release and massage are often used in combination to relieve pain and dysfunction. Myofascial release is gentle stretching of the fascia including techniques such as cross hand release, skin rolling, trigger point pressure and scar release. Massage includes deep tissue work to relieve tight muscles. The combination of the above treatments can be extremely helpful in relieving pain and improving function.

By: Amy Smoot, LMT

Tuesday, June 12, 2012

Fellowship Trained Surgeons

After an orthopedic surgeon completes their 5-year residency training, they choose a sub-specialty within orthopedic surgery to focus on throughout their career. They apply for a 1-year fellowship program in their area of interest, and upon completion, they are "fellowship-trained" in their domain. Fellowship-trained surgeons can go into academic practice or private practice. By hiring orthopedic surgeons who are fellowship-trained, we ensure that each of our surgeons have extensive expertise in their area of interest.

Monday, June 11, 2012

Acupuncture as a form of treatment

The most common condition I treat with acupuncture is probably chronic lower back pain that has been unresponsive to other treatments, and the most common diagnosis is spinal stenosis. Acupuncture ends up providing some benefit for about half of these patients. Acupuncture is also useful for numerous other conditions such as neck pain, myofascial (muscle related) pain, stress related conditions, headaches, and knee and hip pain due to arthritis. I am also personally interested in using acupuncture to treat sports-related injuries.

By: Chi- Tsai Tang, MD

Friday, June 8, 2012

Washington University Orthopedics - Spine Center

The Spine Center, conveniently located at our Orthopedic Outpatient Center in Chesterfield, provides comprehensive, specialized care to patients with acute back pain and neck pain. We are committed to seeing patients as soon as possible, and in most cases, appointments are given within 48 hours of your initial phone call.
76 percent of Americans suffer from acute back pain at some time during their lives. The focus of our center is to see patients early in the development of their symptoms and to provide a specific diagnosis and treatment plan. In addition to individualized treatment plans, rehabilitation also includes education regarding body mechanics specific to a patient’s lifestyle.

Thursday, June 7, 2012

Back Pain Prevention Tips

Many of us suffer from back pain on a day-to-day basis. An estimated 60 to 90 percent of Americans experience at least one back injury during their lifetime. Of these people, half will experience recurring episodes of back pain. Most back problems develop over a span of years as a result of different factors - your exercise, how you sleep or sit and your diet. Here are a couple of helpful tips that may help prevent back pain:
  • Exercise to keep your back strong. Aerobic conditioning and strength training can stem off lower back pain.
  • Make an effort to sit and stand upright. Sitting or standing, you should put forth effort to keep good posture. To do this, try to ensure that your ears, shoulders and hips are aligned.
  • Protect your back while sleeping. If you sleep on your side, sleep with a pillow in between your knees. If you sleep on your back, try to put a pillow underneath your lower back. Ensure your mattress also has proper support.
  • Eat a healthy diet. Try to consume foods with vitamin D (found mostly in fish and soy products) and calcium, which helps to prevent osteoporosis.

Tuesday, June 5, 2012

Our Residency Program

Resident physicians are graduates of medical school (MD), and are still completing training in their specialized field of medicine. Orthopedic Surgery is a specialty within the field of medicine, and each year, Washington University accepts 6 new resident physicians into their five-year training program.

Learn more about our program:

Thursday, May 17, 2012

Researchers Exam Trait in Some Female Athletes

Doctors coined the term female athlete triad 20 years ago to describe athletes who had decreased bone mineral density (osteoporosis), disordered eating and irregular menstrual cycles.
But athletes like Hana Kahn, 20, a former field hockey player at Mary Institute and St. Louis Country Day School, are putting a new face on the condition.
Kahn, who now plays field hockey for Middlebury College in Vermont, has had three stress fractures in the past four years — two in her feet, one in her back. For awhile, she had irregular menstrual cycles and low estrogen levels. But birth control pills were able to regulate both.
But she's never been obsessed with her calorie-intake, she said. "I never paid attention to what I was eating. I was kind of along the lines of eating when I was hungry."
Dr. Heidi Prather, associate professor of orthopedic surgery at Washington University, notes how years ago most of the girls and women who were diagnosed with female athlete triad were visibly underweight and had eating disorders such as anorexia nervosa and bulimia.

Read more:

By: Cynthia Billhartz Gregorian

Thursday, May 3, 2012

New Washington University study will focus on athletes & concussions

St. Louis (KSDK) - Several studies are already looking at links between head injuries and depression in retired NFL athletes. Now, new research at Washington University in St. Louis will attempt to study the impact of concussions over time.

Experts want to be clear, the transition to life after football is already complicated for athletes.

But they want to know how much of it might actually be in their heads.
Junior Seau was a friend, his contemporary in the league, so when former Ram, Aeneas Williams heard about his apparent suicide, he was stunned.

Read more here

Monday, April 23, 2012

Get to Know Dr. Heidi Prather

In her office at the new Washington University Orthopedics and Barnes-Jewish Hospital Outpatient Orthopedic Center in Chesterfield, Heidi Prather, D.O., first lowers her eyes, then looks at the ceiling for a moment as she recalls her decision to go into physical medicine and rehabilitation as a specialty and to focus a part of her practice primarily on women.

“I’ve never told this story,” she says. “My mentor during residency, who happened to be male, once looked at me and said, ‘Since you’re going into academic medicine, you’d better figure out these things about women because we men aren’t going to.’ That’s honestly when I thought, ‘OK, that can be my issue.’”

Read more:

Thursday, April 12, 2012

Are you looking for a congenital hand surgeon in St. Louis?

If your child has a congenital hand disorder such as syndactyly (joined fingers), radial longitudinal deficiency, osteochondral defects or extra digits, you are not alone.  Charles Goldfarb, MD, at Washington University Orthopedics in St. Louis is here to help.  Dr. Goldfarb gets to know each family to find out what is important to the family and the child. Then, he devises the most appropriate treatment protocol.  These conditions are not common, and there are few surgeons who deal with these conditions on a regular basis.  Dr. Goldfarb takes pride in working with each family to offer the best treatment possible.

Dr .Goldfarb sees patients at St. Louis Children's Hospital, the Center for Advanced Medicine at Barnes-Jewish Hospital, the Orthopedic Center in Chesterfield and Shriners Hospital for Children.

Learn more about congential hand disorders and follow Dr. Goldfarb's congenital hand blog.

Wednesday, March 28, 2012

Congratulations to our Golf Expo Winners!

The St. Louis Golf Expo greeted hundreds of avid—and casual—golfers at its 2012 event in the St. Charles Convention Center, Jan. 20-22. Barnes-Jewish Hospital and Washington University Orthopedics were part of the crowd of sponsors and presenters that numbered more than 90. If you stopped by one of our three booths, you had a chance to meet and talk with some of us about the hospital and its orthopedics services, grab a quick chair massage, have your golf swing analyzed by a physical therapist, get a photo taken with a St. Louis Rams cheerleader—and enter a contest to win one of five great prizes. Many of you went home with what may have been the most coveted giveaway of the day—the lip balm on a golf ball, complete with clip for attaching to your favorite golf bag or jacket.

Learn more here

Thursday, March 1, 2012

Washington University Orthopedics : Free Tissue Transfers for Extremity Reconstruction

A free tissue transfer requires moving a flap of tissue and the blood supply from one part of the body to another.  When tissue is compromised due to a large bone defect, infection, or radiation, a free tissue transfer can be essential for extremity reconstruction and limb salvage

Postoperatively, patients are closely monitored in an intensive care setting for five days to assure the success of the microsurgical techniques.   After the intensive care, the patient’s specific rehabilitative needs are assessed.  The length of recovery differs from patient to patient.

Monday, February 13, 2012

Taking Off: The Impact of Spaceflight on Musculoskeletal Tissue

By: Mary Ann Porucznik

During the past two years, orthopaedic researchers have had a unique opportunity to study the impact of microgravity, such as that experienced during spaceflight, on musculoskeletal tissues. Over the course of three space shuttle missions, a NASA mouse-tissue Biospecimen Sharing Program looked at the effects of spaceflight not only on bone and muscle but also on cartilage and tendon. Three investigators involved in the program—Stavros Thomopoulos, PhD; Jeffrey C. Lotz, PhD; and Eduardo Almeida, PhD—presented “New Insights into the Effects of Spaceflight in Musculoskeletal Tissues” to members of the Orthopaedic Research Society (ORS).

“This is the dream of every animal studies committee,” noted Dr. Thomopoulos in his introduction; “it was probably the best utilization of animals that I’ve ever seen. The animals were dissected and every tissue was passed on to a different researcher for a specific study.” His studies covered the rotator cuff—from muscle to tendon to bone.

Read more

Friday, February 10, 2012

Female Soccer Players May Face Health Problems - Study

WEDNESDAY, Feb. 8 (HealthDay News) -- Intense training combined with insufficient nutrition may threaten the health of young female soccer players, suggests a new study that finds menstrual irregularities and stress fractures are common among these athletes.
Nearly one in five elite female soccer players reported having irregular menstrual cycles, while 14 percent had a stress fracture in the past year, the study found.
Though the toll of so-called "aesthetic sports," such as dance and gymnastics, and endurance sports, such as running, on young women's bodies has been well studied, soccer has largely escaped scrutiny, said lead study author Dr. Heidi Prather, an associate professor and chief of the physical medicine and rehabilitation section at Washington University School of Medicine in St. Louis.

Read More

Thursday, February 9, 2012

Learn more about our orthopedic residency training program

Read Orthopaedics Linked In!

Dr. Larry Lenke Discusses Frequently Asked Questions About Scoliosis

Why does scoliosis develop most often in late childhood? And why is it more common in girls? 
Scoliosis most often develops in late childhood because of the association between growth and progressive scoliosis curves. Although scoliosis can develop at any age, including infantile (age birth- 3), Juvenile (age 3-10), adolescent (age 10-18) and adult (> age 18), the most common time to detect curves are in late childhood/early teen years. Thus, the most common form seen, Adolescent Idiopathic Scoliosis (AIS), is detected between ages 10 and 18, often just before or after puberty and the associated adolescent growth spurt. Small curves (10-20 degrees) are nearly equally found in boys and girls, but larger curves which often need treatment (those > 40 degrees) are seen in females to males in a 9:1 ratio. It is a bit unclear why that is the case, it may certainly be a genetic tendency, and/or something relating to hormonal alterations or connective tissue adaptations for the potential for childbirth in females.