Category Archives: Doc Blog

DID YOU SAY SPORTS INFECTIONS?

MRSA

Most athletes expect injuries and not an infection to be the thing that would most likely make them miss some time. Viral, fungal, and bacterial infections can not only take a person out of the game, but can be serious enough to require hospitalization. Recent outbreaks of Staph infections at schools and even ones affecting professional teams (e.g. Tampa Bay Buccaneers) have shed light on the issue, but many athletes are still unaware of the potential for infection in locker rooms, outdoor sporting activities, and even among family. Here are some commons infections that can afflict athletes.

sports-injury-infection-spot-it-stop-it-8-638

Staph Infections

Perhaps the most dreaded and serious of them all are the Staph bacterial infections. Most recently, there has been a surge in community-acquired MRSA infections (a resistant strain) that often affects those with poor hygiene, who live in crowded situations, and have had recent trauma to the skin. They are particularly common in wrestlers, football players, and anywhere there is shared use of contaminated equipment. A recent study showed that there was a 22% prevalence of Staph in locker room whirlpools in college training rooms. It will often present as a red, painful bump but can also develop into abscesses and further soft-tissue infection. Prevention is key with frequent hand washing being the most important prophylaxis. How it presents determines how it is treated. Fluid collections should be drained and all patients should be placed on antibiotics that target the resistant form. Returning to play, per various groups’ guidelines, should only be considered after treatment for 72 hours, no new lesions for 48 hours, and no drainage being present.

Infectious Mononucleosis (IM)

Also known as “kissing disease”, IM is a common viral infection that affects teenagers and young adults, and is often caused from sharing water bottles. Patients will experience a sore throat, body aches/pains, fatigue, fevers, and possibly a rash, and it may take upwards of a month for symptoms to present themselves after one is exposed. The most concerning feature associated with IM is spleen enlargement. When an athlete’s spleen is enlarged, especially contact athletes, this puts them at risk for having the spleen rupture, and, while although rare, can be potentially fatal. IM symptoms usually disappear after 3-4 weeks but may take longer till an athlete is ready to return to sports. Controversy exists with regards to when a contact athlete with IM is safe to return to sports, but most studies show that is probably safe after 4-6 weeks for them to return to play.

Fungal Infections

Caused by direct skin-to-skin contact, fungal infections are quite prevalent and can affect all parts of the body. “Athlete’s foot”, “jock itch”, “ringworm” all fall into this category. While they don’t usually cause too much in the way of significant health issues, they can cause athletes to miss quite of bit of practice and competition time. Most commonly, treatment is in the form of topical creams/ointments, but for more serious cases oral treatment may be needed. Current guidelines recommend 72 hours of topical treatment for non-scalp infections and having a protective dressing over all lesions for return to play.

Summary

While infections are an often overlooked cause of athletes and patients missing time from their sports or activities, they can be just as frustrating as an injury with regards to time off, treatment, and recovery. Sarasota Orthopedic Associates is driven to helping get their patients back in the game, no matter the cause.

Trevor Born, MD – Dr Born is a Sports Medicine physician at Sarasota Orthopedic Associates specializing in upper and lower extremity conditions. SOA has three convenience locations in Sarasota, Lakewood Ranch, and Venice and offers same day appointments when needed.

TENNIS ANYONE?

tennis racket and ball

Tennis is one of the more popular sports on the Gulf Coast of Florida. Year round competition at all levels can unfortunately lead to various “overuse” injuries, and some athletes may even sustain acute traumatic injuries which may force them to miss time. An overview of common injuries as well as ways of preventing and treating them may help to keep a tennis player on the court.

Tennis Elbow

Perhaps the most dreaded of all the overuse conditions is “Tennis Elbow,” or lateral epicondylitis. A degenerative process affecting the tendons on the lateral aspect of the elbow, which help to bend the wrist backwards, it is commonly seen in tennis players given that these muscles help resist impact when the racquet strikes the ball. Combined with their importance in gripping the handle, these muscles/tendons are prone to overuse if not properly prepared. Strengthening, a regular warm-up routine, and paying attention to grip size can help minimize the risk of developing the condition. Treatment often includes rest, therapy, braces, medications, and injections. While most cases improve with these conservative measures, occasionally surgery is needed.

Shoulder Injuries

The shoulder, like the elbow, is also predisposed to overuse injuries in tennis players. The serve is a complex motion that not only requires a balance of muscle coordination around the shoulder, but good core and lower extremity flexibility and strength to minimize risk of injury. The rotator cuff muscles can often become fatigued or weak, which can throw off the balance, and irritate surrounding tissues. The tendons and surrounding bursa can become inflamed, which may affect one even off the court. Again, conservative treatment is often all that is needed, not only focusing on the shoulder, but providing a total body program to minimize the stress on the shoulder during strokes. If symptoms persist, then further imaging and possible surgery may be needed, especially if a rotator cuff tear is present.

tennis_injury_map_all

Lower Extremity Injuries

The legs are just as important as one’s arms on the tennis court. Rapid changes of direction, sudden stopping and acceleration, and jumping are often needed during a match. Muscle strains, knee and ankle sprains, and stress injuries can occur during these movements. Strains, such as “pulling” a hamstring or calf muscle, can often be prevented by adequate stretching prior to playing. An awkward step or twisting episode may result in a sprain. Ankle sprains almost always improve with conservative measures, but recurrent sprains may result in continued instability and require surgery. Knee sprain treatment depends on what is injured. While certain ligament and tendon issues around the knee can heal with non-operative treatment, meniscal and ACL tears often need surgery, but this is determined on a patient-to-patient basis.  Quickly increasing the amount of tennis one is playing may predispose them to a stress fracture, either in the lower leg or foot. These require rest and off-loading of the limb, possibly with the assistance of crutches. Lastly, proper footwear is vital to the health of the lower extremities and minimizing the risks of these conditions.

Summary

Understanding the spectrum of conditions that can affect tennis players is often a good first step into learning ways to avoid them. Every patient/athlete is unique and working with them through their condition in a customized approach will best enable them to get back in the game.

Trevor Born, MD  is a Sports Medicine Physician at Sarasota Orthopedic Associates treating upper and lower extremities with non-surgical treatment as well as minimally invasive options. Click HERE for more information.

 

SHOULD MY CHILD PLAY THE SAME SPORT ALL YEAR LONG?

sports blog lento

Ahhh!!! Florida, with its beautiful warm sunny days and virtually endless opportunities for sporting events, is a hotbed for the development of youth sports.  Here in the Sarasota/Bradenton area, there are numerous opportunities for the young athlete to participate in sports year round.  Too often, however, young athletes are playing only one sport all year long without the potential for rest or recovery.

Unfortunately, sports medicine specialists now understand that this is not a healthy strategy. In fact, young athletes who play or perform a single sport greater than eight months out of the year are at a significantly increased risk of experiencing an injury compared to the other youths who participate in different sports.  In a recent sports medicine article, youth athletes who focus on a specific specialization of sport program are twice as likely to get injured compared to their friends who participated in self-directed unstructured free play.

There are a few theories as to why this may occur. Playing only one sport may overload developing structures causing overuse injuries.  Additionally, proper development of other diverse muscle skills which occur during regular free play or from participating in array of different sports may not occur when a child only plays one sport.

Based on these theories, it is recommended that young athletes be given time away from their specific sport so that they can participate in free unstructured play with their peers.  Parents and educators should provide opportunities for free play as well so that our young athletes can improve their motor development in general during the growing years which can reduce injury rates and encourage life-long activity free of injury.

Paul H. Lento, MDDr Lento is Fellowship Trained and Triple Board Certified in Physical Medicine.  He is a nationally recognized Sports Physician having served as team physician for major sporting events such as Winter Olympics and major city marathons. Locally he is team physician for Lakewood Ranch High and Booker High Schools. He holds the distinction being named a Castle Connelly Top Doc and sees patients at Sarasota Orthopedic Associates.  Learn more HERE.

YOU’RE GOING TO STICK A CAMERA IN WHERE? The Basics of Ankle Arthroscopy

foot pain 1

You have probably heard of, or know someone who has had, a knee or shoulder arthroscopy or “scope.” What you may not know is that we can also perform arthroscopy of the ankle. This can be a quite useful procedure for some common ailments of the ankle. This is frequently performed as an outpatient procedure with a few small incisions.

During ankle arthroscopy a small incision about ¼” long is made over the front of the ankle. This small incision allows us to place the camera into the ankle joint and see the cartilage covering the tibia, talus and fibula (the bones that make up the ankle joint). We then make a second 1 /4“ incision that allow us to insert a second tool such as a probe or motorized shaver that we can use to assess and clean up damaged tissue. Being able to visualize the ankle joint from the inside out allows us to treat some conditions with much smaller incisions than would be possible otherwise.

ankle_arthroscopy_portals

We commonly clean up damaged cartilage or inflammation of the lining of the joint through the ankle scope. We can also perform procedures such as micro-fracture or grafting which can help stimulate healing of damaged cartilage. Recently, we have been using ankle arthroscopy to prepare the ankle joint for fusion by scraping out any remaining cartilage. This has been incredibly helpful because it allows us to perform an ankle fusion procedure through 4 or 5 small incisions instead of 1 or 2 quite large incisions. This has resulted in lower levels of pain and fewer issues with wound healing.

anklearthritis_clip_image006

If you have been having problems with your ankle, whether it is new or quite old, come see me at Sarasota Orthopedic Associates. We have many options both surgical and nonsurgical for getting you back on your feet… back to work… back in the game… back to life.

For an appointment with Dr. Eric James, orthopedic foot and ankle surgeon, call 941-951-2663.

For more detailed information on foot and ankle arthroscopy, check out this excellent article at the American Orthopedic Foot and Ankle Society website.

http://www.aofas.org/footcaremd/treatments/Pages/Ankle-Arthroscopy.aspx

happy foot

OFF BALANCE? IT’S MORE SERIOUS THAN YOU THINK

balance high wire

Studies have shown that 40% of us will have a balance issue at some point in our lives. Some of these issues will be the catalyst for us to see our physician. A balance disorder is a condition making one feel unsteady or dizzy. Any number of things may cause a balance disorder including:

  • Ear infection
  • Head injury
  • Medication
  • Low blood pressure
  • Eye/Vision problems
  • Arthritis
  • Inner ear condition
  • Brain disorder
  • Weak muscles or bones
  • Aging

Proper balance is important to daily living.  A good sense of balance helps us bend over without falling, rise from a chair without tumbling, turn without tipping over, and walk without stumbling. Balance is critical to maintain our independence and enjoy our daily life. Good balance functions as a result of many systems in our body working in harmony. The eyes, ears (vestibular system), and sense of surroundings, when working properly together, help us to stay upright. These tell the brain how to work with our musculoskeletal system and maintain balance.

The CDC (Center for Disease Control) says one-third of adults over 65 fall each year and among those even older, falls are the leading cause of injury related deaths. As we age, our sense of balance can deteriorate, however, there are some simple things we can do to slow the process.

balance with chair

  • Keep moving. One of our physicians’ favorite phrase is “motion is lotion”. Exercise is, indeed, our best defense against many conditions.
  • Build balance. Try standing on one leg for 30 seconds, increasing your time each day. Stay close to a counter or table for support.
  • Biking helps bone density and strengthens your muscles to help avoid falls.
  • Proper stretching of your calves will build strength and stability in legs and feet.
  • If you’re able, plank exercises help build your core.

With any exercise program or even increasing your daily activity, it’s advisable to consult your physician first and discuss any limitations you might have. At Sarasota Orthopedic Associates, we take care of your bones, joints, tendons, and muscles. Click HERE to learn more about us.

THANKSGIVING – A REFLECTION

Happy-Thanksgiving-Cornucopia-3

The Thanksgiving holiday has come to mean so many things:  family, food, football.  Most of all it’s a day to reflect on our gratitude for those in our lives who bring us joy and the opportunities we are afforded throughout our lives.

“A thankful heart is not only the greatest virtue, but the parent of all other virtues.” Cicero

As you celebrate the day and give thanks for whatever is dear to you …  family near and far, your work or the enjoyment of retirement, the support of friends, the gift of freedom, abundance of nourishment, your journey through life … reflect on the goodness.  Here is some Thanksgiving trivia to help you appreciate the journey of the Thanksgiving holiday:

  • Most people think the holiday started in 1621. In reality, it was the result of a good harvest and the “day” was a three day celebration. The Indians brought five deer as a gift for the Pilgrims and venison was served along with corn, barley, and chicken. Not a turkey or potato was in sight.
  • The tradition technically started in 1789 when President George Washington proclaimed a day in November an “official” Thanksgiving but was not celebrated every year.
  • Thanksgiving wasn’t celebrated nationwide until the 19th century.
  • Sarah Hale, a writer, petitioned to make Thanksgiving an annual national holiday, creating recipes for turkey, stuffing, and pumpkin pie for the occasion.
  • During the Civil War, President Abraham Lincoln proclaimed the final Thursday of November as the national holiday.
  • During the Great Depression, President Roosevelt moved the date one week earlier to encourage retail purchasing for the holidays and boost the economy.
  • In 1941, it was moved back to the traditional fourth Thursday of November.
  • The annual Presidential Pardoning of the Turkey began in 1989 and has continued each year since.

SOA is thankful every day for each and every one of you … our patients, our friends, our families, our vendors, our referring primary care physicians, our staff, and our charitable partnerships.  Sarasota Orthopedic Associates wishes you a holiday filled with reflection, health, joy, and thankfulness.

Thankful

 

DON’T WORRY BABY … WE’VE GOT YOU COVERED

baby fragile

Sure, playgrounds are the most obvious place for a childhood injury or fall, but what about other places? Children are creative, curious, and uncoordinated, as well as energetic and a fall can happen in an instant, with or without supervision. Falling and injuries are a natural occurrence of childhood resulting in cuts, bruises, sprains, fractures, broken bones, and even concussions.

The CDC (Center for Disease Control) reported over 8,000 children nationwide are seen each day for fall injuries. Children under 5 years of age represent the highest proportion of childhood fall emergency room visits.

baby arm

Prevention is the best remedy and the #1 rule is supervision. Reported common injuries are from:

  • Falls from windows – Window screens do not adequately prevent a child from falling out of a window. Best practice is to never place a child on or near a window sill. Window guards on those above one story add an extra safety measure for your child. When closed, keep windows locked.
  • Bouncy seats/portable car seats – These should never be placed on a table. A child vigorously kicking and bouncing may slowly move the carrier to teeter over the edge.
  • Stairs – A gate is an excellent deterrent to prevent serious falls down a staircase.
  • Shopping carts – Never allow a child to stand in a shopping cart. A loss of balance or any slight movement from the child or even being bumped into by another cart can send a child tumbling to the ground.
  • Cribs – Always ensure the rails are raised and locked. Children are masters of escape in an unsecured crib. It’s also wise to frequently check all parts of the crib for any loose parts.
  • Changing tables – It seems to take a contortionist to navigate changing a baby and reaching for changing supplies while keeping one hand on the baby, but maintaining constant contact will avoid the possibility of the child falling from the table.
  • Beds – Jumping on a bed is great fun however, it can be dangerous. Bunk beds without safety railings are an accident waiting to happen.
  • Sports – Always, always, always have your child outfitted in the sport-appropriate protective gear.
  • Playgrounds – Look for those with wooden chips or sand and avoid playgrounds with cement or grass.

baby stairs

It’s hard to keep our children safe from everything, but close supervision is the best preventive measure.

If your child does suffer an injury, it’s good to know Sarasota Orthopedic Associates treats children as well as adults.  Our pediatric orthopedic specialists and sports medicine physicians are here to help get your little ones back in action.  We have offices in Sarasota, Lakewood Ranch, and Venice and, when needed, offer same day appointments. Visit our website at www.soa.md for more information about us.

 

 

 

 

 

CERVICOGENIC HEADACHES

Headache1      cervicogenic headache

Cervicogenic headaches are characterized as head and neck pain originating from the cervical region, a type of secondary headache. This classification is due to the source of the headache being in the neck.  Cervicogenic headaches may be from muscle pain and spasms of the neck muscles, cervical facet joints, or the occipital nerve, located at the base of the skull.  Multiple studies have indicated that cervicogenic headaches may be under-diagnosed, with estimates of prevalence ranging from 2% up to 22%.

Any injury to the neck or cervical region of the spine can lead to cervicogenic headaches. This injury may be an acute, sudden injury resulting from an automobile accident, a sports-related injury, or a fall, or it may be the result of a long-term sustained injury caused by bad posture or degenerative changes with age.

Cervicogenic headaches rarely present auras or nausea that are commonly associated migraine headaches and the pain is not responsive to traditional migraine medications.  However, cervicogenic headaches have been known to precipitate migraine headaches. Appropriate diagnosis of cervicogenic headaches is done by a thorough history and physical exam. Another way in which cervicogenic headaches can be readily diagnosed is if treatment of the neck is able to provide rapid relief from the headache.

PT myofascial release

The specific treatment for cervicogenic headaches varies by patient and by what is found to be the cause of the headaches. If the problem found in the neck is a result of musculature, then muscle-specific treatment options may provide relief. Such treatments include muscle relaxants, physical therapy including myofascial release, and/or trigger point injections into the muscle. For patients whose cervicogenic headaches are a result of damage to the cervical facet joints, there is often underlying inflammation contributing to pain generation. In this case, an interventional procedure known as a radiofrequency ablation (RFA) can block the pain signal being generated from the joints. To directly address the nerve triggering the cervicogenic headache, the occipital nerve, nerve blocks can be administered to inhibit the problematic signaling.

Appointments are made by calling 941.951.BONE (2663). Visit our website by clicking  here for more information about Sarasota Orthopedic Associates.

SKINNY JEANS – RIPPED FROM THE HEADLINES

Skinny-Jeans-2

A few months ago, several news outlets reported the case of a 35 year old female whose legs became so swollen and weak making her unable to walk. Upon being taken to the emergency room, her pants had to be removed by cutting and peeling them off due to excessive tightness. Apparently she was the victim of the fashion phenomena called Skinny Jeans. The circulation in her legs and feet slowed from wearing the jeans for a long period of time. She had been helping a friend move, requiring stooping and bending, which further exacerbated her condition. The diagnosis was compartment syndrome, a serious condition resulting from increased pressure on the nerves and muscles.

In the seventies, Swedish scientists labeled it the “Swedish Tight Pants Theory” after determining low sperm count was to be blamed on men wearing trendy tight pants. The same cause of infertility in men was attributed to UTI’s in women. Skinny jeans aren’t the only fashion culprit. Control top pantyhose and tummy control undergarments can be equal offenders in cutting off circulation.

Numbness in the leg from a sensory nerve can be caused by wearing clothing too tight. Dr Nicholas Morris, a vascular surgeon at Columbia University Medical Center indicated “the condition itself is not dangerous, but repetitive episodes may cause permanent damage.”

So what is one to do when fashion and health clash? To quote Sir Francis Bacon, “knowledge is power”. Several conditions can lead to poor circulation, not just tight pants. Common causes are diabetes, obesity, and heart problems.

Know the signs of poor circulation; a few are numbness, digestive issues, cold hands and feet, appetite loss, exhaustion, and difficulty thinking clearly. It’s also good to know that there are things you can do to improve circulation. Super foods like oranges, ginger, garlic, salmon, and even dark chocolate help, as does drinking water, cutting caffeine and alcohol. Other things you can do: reduce stress levels, elevate legs, increase physical activity, and get a massage.

Most compartment syndrome conditions are caused by an injury or fracture. Bottom line, the fashionable skinny jeans are fine in moderation … just pay attention to the warning signs and your physical activity when wearing them.

skeleton-jeans

Sources:  Business Insider, 6/22/15; CNN; The Ergonomenon; Washington Post; Natural Living.

USING ULTRASOUND TECHNOLOGY TO DETECT CAUSES OF PAIN

back pain2

Musculoskeletal Ultrasound (US) is a non-invasive office-based diagnostic test that uses non-painful ultrasound waves that creates images of various structures in the body. These images help elucidate the various causes of orthopedic pain such as tendon tears, muscle contusions, and even early stress fractures of bone.

Unlike x-rays, which use harmful ionizing radiation, US is completely safe even in patients with pacemakers and other types of surgical hardware who may not be able to receive an MRI. Patients also do not need to worry about getting into a narrow tube, which can cause some patients to become extremely claustrophobic.  In fact, in a comparative study, patients preferred getting a diagnostic US compared to undergoing MRI scans.

ultrasound1

Since US can be used while a patient is moving, it is a great diagnostic test to determine causes of pops, snaps, or clicks occurring about joints, muscles or tendons. Additionally, it can not only help identify the underlying problem causing the pain, but it can also help guide a therapeutic injections.  When performed under US-guidance these procedures have been shown to be less painful and more effective in treating various orthopedic conditions compared to more traditional procedures.

 Dr Paul Lento, a non-operative board certified sports medicine specialist at Sarasota Orthopedic Associates, has been performing Musculoskeletal US since 2003 and has published book chapters and journal articles on the topic.  Additionally, while lecturing nationally and internationally, he has trained several hundred physicians on Musculoskeletal US.  He is fellowship trained and certified as a Registered Musculoskeletal Sonographer (RMSK) and has been using non-surgical treatments for various musculoskeletal conditions since 2000.   Here at SOA, our doctors strive to provide the latest strategies, which help get our patients back on their feet, back to work, back in the game, and back to life.