Tags: Bradenton, concussion management, sports medicine
Featuring Bradenton’s Only Physician Credentialed in the ImPACT Testing System
According to the Centers for Disease Control and Prevention (CDC), over 1 million people a year sustain a concussion injury. If left untreated or undiagnosed, a concussion may lead to long-term brain damage, like sleeping problems, mental disorders and depression. To assist patients in lowering their risk of the lasting effects of a concussion, we’re announcing the launch of a Comprehensive Concussion Program lead by our newest Physician and Concussion Management Specialist, Jeremy Ng, MD.
From diagnosis, to treatment, and recovery, the program will consist of a full spectrum of concussion management services, which include:
- Complete medical evaluation
- Physical and comprehensive neurological exam
- Computerized neurocognitive assessment using the ImPACT (Immediate Post-Concussion Assessment and Cognitive Testing) Testing System.
Dr. Ng is the first and only Credentialed ImPACT Consultant (CIC) in Bradenton.
In addition to treatment, the Coastal Orthopedics Concussion Management Team will also counsel patients on returning to school and athletic activities, as well as provide recommendations for academic accommodations during recovery and rehabilitation. Awareness is key to prevention, which is why the Concussion Program will also offer presentations and educational materials for school officials, coaches, and parents to help them recognize the symptoms of a concussion and how to respond properly when a head injury does occur.
Patients in the program can be seen at two of our Bradenton-area locations: Pointe West Medical Plaza, 6015 Pointe West Blvd. and Lakewood Ranch Medical Park, 8340 Lakewood Ranch Blvd.
“Expanding our practice to include a Comprehensive Concussion Program allows our team to further provide quality care to our patients,” says Coastal Orthopedics CEO, Paige LeMay. “With the addition of Dr. Ng and his concussion management expertise, we can effectively further our role as leaders in providing cutting-edge medical care.”
Tags: hip pain, sports medicine, young athlete
Femoral Acetabular Impingement Syndrome: A Common Cause of Unexplained Hip Pain
by John R. Ayres M.D.
Femoral Acetabular impingement Syndrome (FAI) is a common source of hip pain, stiffness and loss or range of motion in young adults that may lead to osteoarthritis down the road. It is commonly unrecognized because the changes on x-ray are subtle. First described in 2001, it is increasingly recognized by hip specialists like orthopedic surgeons as a condition that does best when treated early before significant cartilage damage has occurred.
The hip is a ball and socket joint with the head of the femur (thigh bone) making up the ball and the acetabulum, of the pelvis making up the cup. In FAI, there is a mismatch between the anatomy of the femoral head and the acetabular cup which causes impingement, or pinching, of the labrum or articular cartilage during hip flexion. Hip flexion is not only painful, but can lead to injuries of the labrum and/or articular cartilage.
There are two types of impingement, cam impingement and pincer impingement. These may occur alone, but generally there is a combination of the two. Cam impingement, most common in young male athletes, occurs when the femoral head is more oval than round and the head jams up against the acetabulum, resulting in cartilage damage. Pincer impingement, more common in middle aged women, is caused by over-coverage of the acetabulum that leads to pinching of the labrum.
While the condition may require an open surgical approach to address the changes on the pelvic side of the hip, increasingly Arthroscopy, a commonly used minimally invasive surgical procedure for knee and shoulder problems, is being used to treat FAI. In 2008, 30,000 hip arthroscopies were done in the United States and that number is expected to grow by 15% a year to over 70,000 in 2013. The arthroscope can also be used to treat other conditions of the hip including removal of loose bodies and repairing tears in the labrum, the fibrous ring that holds the femoral head in the acetabular cup.
Whether performed arthroscopically, though open techniques or a combination of the two, the goal is to shave off prominent bone, a procedure called an “osteoplasty”, on the femoral neck and/or acetabular cup is causing the impingement, or pinching between the femoral head and acetabular cup. Surgical treatment of FAI pathology is less effective for pain reduction in patients with late stage osteoarthritis. In addition, delay in the surgical correction of bony abnormalities may lead to disease progression to the point hip resurfacing or replacement becomes necessary. It is believed that osteoplasty of the impinging bone is needed to protect the cartilage from further damage and preserve the natural joint. If FAI morphology is shown to be an etiology of osteoarthritis, a future strategy to reduce the occurrence of idiopathic hip osteoarthritis could be early recognition and treatment of FAI before cartilage damage occurs.
Note: Dr. John Ayres and Dr. Daniel S. Lamar, both with Coastal Orthopedics & Sports Medicine/Pain Management in Florida, are the only physicians in Manatee and Sarasota counties (FL) that perform arthroscopy of the hip to treat this condition.
Tags: elbow, orthopedics, sports medicine
By: Arthur Valadie, MD
The Little League elbow is a term used to describe a common overuse injury of the elbow in young throwing or overhead athletes. It is a condition caused by repetitive stress to the inner or medial aspect of the elbow. The throwing motion in particular puts significant tensile forces on the medial stabilizing structures of the elbow and can cause an overuse injury to the cartilage growth plate in this area.
DEFINITION: The term Little League elbow is specifically used to describe an injury to the medial growth plate called the medial epicondyle. The repetitive stress of throwing causes injury to the growth plate cartilage and can cause inflammation of this tissue as well as alterations in the growth pattern of this growth center. Another overuse syndrome called osteochondritis dissecans is caused by the compressive forces across the lateral or outer aspect of the elbow. While not strictly defined as Little League elbow, this condition is still commonly found in young throwing or overhead athletes.
CAUSES: We now live in an age where young athletes are commonly encouraged to play a single sport year-round and where athletic performance is being stressed in younger and younger athletes. This has resulted in young pitchers throwing too hard, too frequently, and without enough rest, causing an increasing incidence of overuse injuries in skeletally immature athletes. It is estimated that at least a third of young baseball players experience some sort of overuse injury during their adolescent years.
SYMPTOMS: The typical player that experiences Little League elbow develops pain on the inner aspect of the elbow with throwing. He or she may also develop some swelling and localized tenderness. It is also commonly associated with decreased velocity and/or accuracy. Typically, the pain is of gradual onset, but occasionally can occur fairly acutely.
DIAGNOSIS: The diagnosis of Little League elbow is commonly made with simply a combination of a description of the symptoms as well as a physical examination. Again, there is typically localized tenderness over the medial aspect of the elbow. There is commonly pain while applying a stress to the medial ligaments. X-rays are occasionally helpful in the diagnosis as they may show some abnormal appearance to the medial elbow growth plate. Other conditions caused by increased compression of the lateral or outer surface of the elbow may also be seen on an x-ray. MRI scanning is not typically needed to diagnose Little League elbow.
TREATMENT: As with most overuse conditions, the most obvious and effective treatment is often the hardest one to comply with; rest from the offending activity. The most important treatment for Little League elbow is to avoid throwing for a period of time to rest the injured structures. This may take several weeks, but it is important to allow complete healing to prevent recurrent symptoms. It is also important to maintain range of motion during the rest period. Ice, anti-inflamatories, and physical therapy to maintain range of motion and strength can also be helpful. It is also important during the rest period to avoid other activities that may place a stress on the injured structures of the elbow. Once an athlete begins to throw again, it is important that he or she resume throwing in a gradual controlled manner. If a player ignores the symptoms and continues to throw despite pain, they are likely at increased risk for a fracture of the medial growth plate of the elbow, which could potentially require surgical intervention.
PREVENTION: The best way to avoid Little League elbow is to follow appropriate preventative steps. It is important that players’ parents and coaches be educated as to the cause of Little League elbow. Pitch counts, rotation schedules, and throwing mechanics can then be managed in an appropriate way. Pitchers who are 16 and under should not throw more than 60 pitches in a day and there should certainly be adequate rest between pitching appearances. If a pitcher does throw close to 60 pitches, the rest period should be at least 3-4 days. Through appropriate education and monitoring, the incidence of Little League elbow and other overuse conditions can be reduced.