Learn about our role as Team Physicians for the Rams

Dr. Wright discusses ACL injuries

To learn more about our orthopedics department please visit: http://ortho.wustl.edu/content/Patient-Care/2495/Services/Sports-Medicine/Overview.aspx

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: https://news.wustl.edu/news/Pages/24036.aspx

Your Questions answered by Dr. Brophy and Dr. Halstead

YOUR QUESTIONS ANSWERED

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.

Dr. Matava discusses knee injuries

Head to our website to learn more about our sports medicine department: http://ortho.wustl.edu/content/Patient-Care/2495/Services/Sports-Medicine/Overview.aspx

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.

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: http://ortho.wustl.edu/content/Patient-Care/2495/Services/Sports-Medicine/Overview.aspx

Dr. Rick Wright discusses his role as Team Physician for the B...

To learn more about our sports medicine department head to our website: http://ortho.wustl.edu/content/Patient-Care/2495/Services/Sports-Medicine/Overview.aspx

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 https://twitter.com/wustlortho.

Learn more about our sports medicine update here at: http://ortho.wustl.edu/mm/files/news/smuBrochure_r2_comp.pdf

Matt Matava, MD, discusses his role as team physician for the St. Louis Rams

Meniscus Tear Overview

Dr. Matava discusses meniscus tears:



Head to our main page to learn more about our sports medicine program: http://www.ortho.wustl.edu/

Hirsch Twins Story of ACL Reconstruction

They 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.”

Dr. Brophy discusses rotator cuff injuries

Read more about Dr. Brophy at http://ortho.wustl.edu/content/Patient-Care/2793/Find-a-Physician/Listing-of-Faculty/Robert-Brophy-MD/Bio.aspx

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

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.