Tag Archives: Dr Trevor Born

What’s That Sound? SNAP, CRACKLE, POP

knuckle cracking

It’s a question most orthopedic surgeons get asked on a daily basis: “My joint pops…is that normal?” Like most things in life, if it’s not broke (or hurting), don’t fix it. An acute injury resulting in an audible “pop” is different from a situation such as a hip “popping” for years. Popping, cracking, or crunching of joints is quite common and often nothing to be too concerned with, especially if it is not causing discomfort or affecting one’s activities. Here are some need to know tidbits on joint popping and cracking.

What Causes This?

  • Numerous theories and causes exist including ligament stretching, tendons snapping, nerves subluxing, or bubbles forming within the joint. A recent study investigated the bubble theory using MRI videos to propose the mechanism by which “cracking” your knuckles results in a negative-pressure event which draws synovial fluid into the joint, thus leading to the subsequent pop. Why does it feel good to crack a knuckle? Thoughts are that the pressure phenomenon within/around the joints stimulates certain receptors which allows for muscles to relax. Another theory suggests natural painkillers (endorphins) are released with such activity, which may explain why it can be a difficult habit to break.
  • Other things must also be taken into account when discussing the cause of noise around a joint, such as prior injuries, surgeries, hardware/implants around the joint, and other accompanying symptoms. It is quite common for someone who injures their ACL to feel or hear a “pop” from the ligament rupturing. This must be taken in a different context from the chronic, painless popping that someone may experience around their knee cap from soft-tissue issues.
  • Lastly, arthritis can commonly be accompanied with crunching or cracking sensations and as long as it is not resulting in increasing pain or swelling, it is something that can be observed. Some older style knee/hip implants may result in noises (e.g. squeaking), and if you were experiencing this, it would likely be best to visit with your orthopedic surgeon to check the status of things and make sure the components were not wearing out in an abnormal fashion.

Should I Be Concerned?

In general, if the popping/cracking around a joint is not causing pain or swelling to occur or interfering with your function or activities, there shouldn’t be much concern. Studies have looked at whether or not cracking your knuckles would lead to arthritis, and to date, no such correlation has been shown. That said, it is generally recommended that one not perform such activities too frequently or on purpose as there have been reports of joints/knuckles becoming loose from habitual cracking. In addition, habitual knuckle crackers have been shown to develop hand swelling (not from arthritis) and decreased grip strength which can lead to decreased manual function. Nodules can also form from such activity, and this may cause cosmetic concerns for certain patients.

Common Areas to Experience It

Any joint can develop it, but perhaps the most common areas to experience it are in the hands, knees, spine, and shoulders.

  • As already mentioned, knuckle cracking is a common occurrence.
  • With regards to the knee, the anterior aspect often experiences popping/crunching from the patellofemoral joint (knee cap). This can be from mild softening of the joint, but most of the time it is from soft-tissues in the area (e.g. plica, fat pad) that simply release themselves during motion.
  • Similar to the knuckles in the hand, the facet joints and other muscles/ligaments around the spine are prone to popping.
  • The spine is a complex unit with numerous muscles, joints, discs, and ligaments contributing to its stability. Chiropractors make a living out of therapeutically popping, cracking, and aligning patients’ backs, so why would you get too concerned with your back popping if you’re not having any discomfort with it?
  • Lastly, the AC joint of the shoulder almost always develops arthritis, but rarely causes too much pain or functional limitation. Popping over this portion of the shoulder with no other symptoms is quite common. On the contrary, patients with symptomatic instability or arthritis in the shoulder joint proper will almost always have pain or issues with their function accompanying this, and would thus be treated differently to the above mentioned scenarios.

Summary

Painless popping around joints is an issue that one should hardly ever get too concerned with. If popping occurred from an acute injury or there were other symptoms being experienced in addition to it, then a visit with your orthopedic surgeon would be recommended at that point. Otherwise, keep up what you are doing and don’t let some painless noise around a joint stress you out.

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Trevor Born, MD is an orthopedic surgeon with a specialty in sports medicine. At Sarasota Orthopedic Associates our commitment is to get our patients back on their feet, back to work, back in the game, and back to life. We have four convenient locations and offer same day appointments when needed. Visit our website at www.SOA.md or call us at 941-951-2663 for an appointment. Appointments may also be made via our website.

 

BAD TO THE BONE: Treating Knee Pain

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The knee is a very complex joint with many components making it vulnerable to a variety of injuries. When damaged, it can seriously impact your quality of life. Knee pain is one of the most common reasons people visit an orthopedic physician. Difficulty standing and walking can greatly diminish your sense of independence. The GOOD news is that most collective knee pain problems are treatable.

The CAUSES OF KNEE PAIN are many, including injury and disease. Injuries of the knee commonly seen tend to be damage to the anterior cruciate ligament, or ACL, and the meniscus. There are an estimated 2.5 million sports-related injuries a year just by adolescent athletes alone. A fracture is most often caused by trauma such as a car accident, a fall, or sports contact; the most common broken bone in the knee is the patella, more generally known as the kneecap.

Fast facts on knee injuries:

  • The highest knee injury rates occur in people between the ages of 15 to 24.
  • Sports participation is a high risk factor for knee injuries.
  • 60% of high school sports-related injuries occur in the knee.
  • Female basketball and soccer athletes are as much as 8 times more likely to suffer an ACL injury than a male.
  • Young athletes suffering an ACL injury will have an increased risk of arthritis as they age.

Orthotics-for-knee-pain

Avoiding knee injuries:

  • Warm up properly prior to exercising or participating in sports.
  • Wear proper footwear with a good fit.
  • Don’t increase sports or exercise workouts suddenly.
  • Wear knee guards in sports activities.
  • Maintain strong, flexible leg muscles.
  • Always, always, always … Use a seatbelt when driving.

The MOST WIDESPREAD DISEASE affecting the knee is arthritis, which is caused by the gradual wearing-away of cartilage. Primary symptoms are pain, swelling, and stiffness in the knee. Currently, there is no “cure” for arthritis, however there are options, both surgical and non-invasive. Depending on the amount of arthritic damage, treating knee pain may often be done without surgery. These options may include one or a combination of physical therapy, weight control, injections, medications, bracing, exercise, and strengthening. When considering knee replacement surgery, the physicians and physical therapists at Sarasota Orthopedic Associates have a wide array of experience and expertise.

Whatever the cause of your knee pain, from sports injury to trauma to arthritis, the 13 physicians at Sarasota Orthopedic Associates are here to help alleviate your discomfort. We have four convenient locations. Browse here to view our physicians and their specialties or call us at 941-951-2663 to make an appointment.

Sources: SOA.md website; MediLexicon International; arthritis.org; webMD

One-on-One with Trevor Born, MD

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The past few weekly blogs have provided insight to our physicians on a personal level with our one-on-one interviews.  This week, we sit down with Trevor Born, MD, who is Fellowship Trained in Sports Medicine. Dr Born is a Bradenton native with impressive local accolades and we’re so pleased he returned to Florida after completing his medical education.

What inspired you to become a physician?

A couple reasons: Seeing the positive role physicians have in their patients’ lives, including my family members. Also knowing that physicians are constantly challenged and driven to continue the learning process not only for themselves but to further advance their patient care abilities.

Why orthopedics?

Why not? I was mainly drawn to orthopedics from my love for sports. I always thought, “Man, how awesome would it be to be the team doc for the Gators?” Coupled with the fact that building, architecture, and math were always passions of mine, the decision to pursue Orthopedics was a pretty easy one for me to make.

What do you love most about your job?

Establishing relationships with patients as I treat them for their chronic conditions or as they proceed on their journey to recovery from a serious injury. That about sums it up.

What is your biggest challenge?

Following Gator sports too much and their recent struggles? Really though, the most difficult struggle in today’s medical landscape is finding more time to care for and get to know my patients.

If I weren’t an orthopedic physician I’d be an ________

Architect, teacher, or musician.

Your proudest moment?

That would be whenever I receive a letter from a patient or their family members letting me know how thankful they were for the care I provided.  Not many other moments out there make me feel as thankful and proud of my role as a physician.

Where is the most interesting place you’ve travelled?  Why?

Yellowstone National Park. The natural wonders and wildlife, scenery, volatile terrain, and how much of it is still truly unknown makes it pretty interesting in my mind.

Any hobbies?  Activities?

Guitar/music as I have been playing since middle school and there is never a party that could not benefit from a little guitar. When I have the chance I like following Gator sports and continuing to play golf, basketball, and tennis.

What’s your next adventure?

Starting a family.

Your guilty pleasure food?

Dark chocolate.

NOTE: Trevor Born, MD is Fellowship Trained in Sports Medicine with a specialty in upper and lower extremities. You may read his professional medical biography by clicking here.  Dr Born is one of 13 SOA physicians in four locations (Sarasota, Lakewood Ranch, Venice, and Bradenton). Sarasota Orthopedic Associates offers same day appointments when needed.  Our commitment is to get our patients back on their feet, back to work, back in the game, and back to life.

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.

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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.

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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.

 

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.

 

 

 

 

 

ANATOMY OF A GOLF SWING

golf-swing

With today’s modern golf swing, there are numerous muscle groups and joints which need to be on the same page to best provide one with an effective, powerful stroke while minimizing the risk of injury. An often neglected part of the body with regards to many players’ swings is the hip joint and its surrounding structures.

Prevention

Placing focus on properly preparing the hip joint to maintain appropriate flexibility will best ensure that it can withstand the forces seen with one’s golf swing. Basic stretching exercises for the hamstrings, hip flexors, and rotators are essential. The average PGA golfer has roughly 45° of hip internal rotation. Lacking internal rotation leads to increased extension of a golfer’s pelvis which can result in low back pain and decreased drive. In addition, recent studies have shown that golfers with strong hip musculature have lower handicaps and longer driving distances compared to those with weak hip muscles. Combined with safe core strengthening, these steps will help one produce the maximum power with their swing while reducing the risk of back and other joint injuries.

Causes

Hip pain in golfers may be the result of minor strains, soft-tissue inflammation, such as bursitis, and even arthritis. The modern golf swing, with its requirement for large amounts of body rotation, can subject one’s body and hip joint to perhaps more than it can tolerate, rendering it vulnerable to injury. Labral tears, while perhaps more common in other sports, can also be a cause of hip pain in golfers. A stabilizing and supportive structure, the labrum can be damaged when subjected to increased pressure in a hip joint which lacks the necessary flexibility to withstand the forces seen with the modern golf swing. This may result in groin pain, clicking or locking sensations, discomfort when squatting to read a putt or pick up a ball, or even restricting one’s swing.

Treatment

The first steps to take in treating hip pain associated with golf involve the usual conservative measures, including rest, ice, and over the counter pain relievers and anti-inflammatory medications. If these fail to alleviate the discomfort, formal physical therapy with an experienced provider familiar with golf related injuries can often target the specific muscle imbalances and tightness which made one prone to such an issue in the first place. Injections, such as steroid and platelet-rich plasma (PRP), can also be useful for a variety of hip related pathologies. Lastly, when non-operative treatments fail, surgery can be considered. For labral tears, recent advances in hip arthroscopy have enabled surgeons to repair this important anatomic structure through minimally invasive techniques, and best preserve the hip joint for countless rounds of future golf.

Our commitment at Sarasota Orthopedic Associates is to get our patients back on their feet, back to work, back in the game, and back to life.  Trevor Born, MD is fellowship trained in Sports Medicine at SOA and will help you get back in the game. Same day appointments are available at any our three locations by calling 941.951.2663.