Current Concepts: Management of Acute Shoulder Instability in Young Athletes

by | Sep 26, 2022 | Sports Medicine

Watch the full lecture.

Our latest presentation from Coffee, Kids and Sports Medicine covers the management of acute shoulder instability in young athletes. Sports medicine physician assistant Ben Johnson, P.A.-C., dives into the differences in instability patterns between the skeletally immature and skeletally mature shoulder, on-field/acute management of shoulder dislocation and evidence-based recommendations for treatment of first-time shoulder dislocation.
 
Johnson begins the presentation by discussing the epidemiology of shoulder dislocations in high school and collegiate athletes in the United States and explains why it matters. He then shares important insight in how children and adolescents differ from adults physically, especially in relation to the capsular elasticity, a smaller anterior-inferior recess and more. Johnson shows the changes that occur in the shoulder as an adolescent enters puberty, and he discusses how this affects shoulder injuries.
 
Next up, Johnson teaches on-field and acute management of shoulder dislocations in pediatric patients and what medical providers need to know. Acute management includes taking a brief history, initial assessment and considering sport-specific factors. He breaks down when and how on-field reductions should be performed, sharing the benefits of early reductions and red flags to consider.
 
Johnson provides an evidence-based review of external and internal immobilization compliance and outcomes, along with the pros and cons of each method. He then answers questions about operative versus nonoperative treatment, breaking down the consequences of each.
 
To wrap up the presentation, Johnson provides a summary on pediatric glenohumeral dislocation and the steps that should be taken when assessing treatment strategies, as well as sharing a treatment algorithm. The presentation is crucial for sports medicine physicians and other medical professionals who treat young athletes, especially those at a high risk for shoulder injuries.

Thumb Fracture Q&A

Thumb Fracture Q&A

by | Sep 23, 2022 | Hand Conditions

Thumb injuries are common, especially in young athletes, and can occur from direct hits, falls on outstretched hands or hyperextensions. We see them often in football, basketball, baseball and soccer.

Pediatric nurse practitioner Courtney Schneidau, P.A.-C., shares information about thumb fractures and how to handle these types of injuries in young athletes.

Anatomy of the thumb
The thumb is made up of two major bones — the distal phalanx and the proximal phalanx. The distal phalanx starts at the tip of the thumb, underneath the fingernail and extends to the knuckle. The proximal phalanx runs from the knuckle to the base of the thumb, where it connects to the hand. 
 
How do thumb fractures typically occur? 
A thumb fracture can occur anywhere in the thumb and is generally caused by a direct trauma, like from a fall or a hit to the hand. For example, if a player hits his hand/thumb on the helmet of another player while playing football.  
 
What are the main symptoms of a thumb fracture? How do you know if the injury needs medical attention? 
Symptoms can include: 
–    severe pain
–    swelling and tenderness
–    limited motion or inability to move the thumb
–    visible deformity or deformed appearance
–    a numb sensation or coldness in the thumb 

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You should seek medical attention if you are experiencing pain, bruising or swelling. It is important for a professional to examine the injury to determine the best course of treatment.

How is a thumb fracture diagnosed and treated?
Your provider will take a detailed history, including the activity that caused the injury, as well as perform a physical exam. X-rays of the hand and injured thumb will be performed to better evaluate the injury and rule out other injuries.

A fractured thumb can be treated through casting or the use of splints, which limit movement while the bones heal. Surgery is sometimes needed, depending on the location of the break. There are different techniques that are used to hold the bones in place, including the use of pins, plates or screws. Following surgery, a splint or cast is worn to ensure proper healing.

What is the outcome following a thumb fracture? 
Thumb fractures generally have good outcomes, following proper treatment and rehabilitation. Once the fracture has healed, hand therapy may be required to help restore motion.

Should you see a pediatric orthopedic specialist for a potential thumb fracture? 
Scottish Rite for Children treats children who need complex reconstruction following trauma or have hand disorders related to neurological conditions or nerve injuries. That includes fractures (shoulder to fingers), nerve injuries, tendon injuries and complex injuries. Our Sports Medicine team treats the comprehensive needs of athletes and provides management for sport-related injuries and conditions. Young and growing athletes are highly competitive and have unique conditions that require care by a pediatric team of experts. Learn more about our centers for excellence in Sports Medicine and Hand and how board-certified pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other specialists work side-by-side with each patient and their parents to develop the best game plan for treatment, rehabilitation and safe return to sport.

Learn more about our Facture Clinic.

Shoes for Different Orthopedic Needs

Shoes for Different Orthopedic Needs

by | Sep 21, 2022 | General News

At Scottish Rite for Children, many of our patients are treated for conditions affecting the lower extremities, such as the legs or feet. Some of these treatments can make it challenging for parents to find the right shoes for their child, so we have some tips and tricks to help navigate shoe shopping and ensure a proper fit.

When Buying Shoes
Most braces are built to fit in athletic shoes. They may also fit in hiking boots or lace-up dress shoes. Sometimes it can still be difficult to find properly fitting shoes. When buying shoes, always fit the shoes to the child with the brace on. Each brand and style of shoe fits differently. With a brace, most children will need wide shoes. Also, shoes with tongues that extend closer to the toe will fit braces more easily.

Shoes from Orthotics
When fitting a new leg brace, Scottish Rite for Children may provide one pair of athletic shoes. This allows us to see how the brace works and will allow your child to start wearing the brace immediately. These will not be replaced when they wear out.

Shoe Lifts or Wedges
Most children like to have several different pairs of shoes to wear, therefore you may want to have multiple pairs adjusted. A shoe lift or wedge can be added to shoes that you provide. For these buildups, drop off or mail the shoes to the Orthotics department. It may take several days to complete the work. Some shoes with silicone or gum rubber soles cannot be modified.

Modifying Shoes to Fit Braces
Certain shoes can be modified to allow them to fit better with a brace. It is important to make sure that the shoe comes close to fitting, before deciding to modify it.

  • Remove the insole.
  • Cut the tongue longer.
  • If the shoe is made of leather, a shoe repair shop can stretch the shoe.

Differently Sized Feet
Most children who wear a single brace, or have different sized feet, can wear the same sized shoes on both feet. Buy shoes to fit the larger. If the shoe is too loose on the smaller foot, try modifying that shoe.

  • Add an additional insole.
  • Pack the toe section of the shoe with cotton balls.
  • Put a dancer’s toe pad in the toe of the shoe.
  • Have your child wear two socks on the small side.

These modifications may not always work. If your child’s feet differ by at least two full sizes, you may need mismatched shoes. The easiest way to do this is to buy two pairs of shoes and discard the unneeded shoes. See the other side for additional resources.

Shoe Stores
A full-service shoe store can help fit your child with shoes.

Mismatched Shoes
If your child’s feet differ by at least two sizes, he or she may need mismatched shoes. Companies that sell single or mismatched shoes:

Services to share shoes between individuals with the opposite shoe concerns:

  • National Odd Shoe Exchange
  • Shoewap
  • Odd Shoe Finder

Special Shoes
Most children are able to wear standard shoes with their braces. However, you may need to special order an extra-wide style. Some models include:

  • BILLY Footwear (toe zippers)
  • Saucony Kids
  • Stride Rite
  • Piedro
  • Plae
  • Apis Mt. Emey
  • Nike FLYEASE (heel zippers)

Download the PDF.

After an ACL Injury: Physical Therapist Explains Quadriceps Strengthening Progression

After an ACL Injury: Physical Therapist Explains Quadriceps Strengthening Progression

by | Sep 20, 2022 | Sports Medicine

The anterior cruciate ligament (ACL) is a supportive structure inside the knee joint. After it is injured, there are many important areas to focus on during recovery including range of motion, flexibility, strength, balance and core strength. Each of these areas, as well as mechanics with running, jumping, sprinting and cutting, must return to normal before returning to sports.
One area that requires extra attention during recovery is the quadriceps (quad), a group of muscles on the front of the thigh extending to the knee. Due to an injury and after surgery, the body’s response is to “turn off” the nerves to the quadriceps muscle.
What is persistent quadriceps weakness?
Some athletes have quadriceps weakness, and this takes longer to get stronger than other muscles. Unfortunately, this weakness can last years, and bodies will find ways to compensate for quadriceps weakness. However, you may be able to do activities like running and jumping while still having poor quad strength. This is because your hips and ankles are able to compensate, which “hides” quadriceps weakness. This continued weakness can change the way the knee is loaded when running and jumping, which might stress the joint over time.
What is the best way to strengthen the quad muscle?
“There are ways to strengthen the weak quad muscle in isolation,” Physical therapist Jacob Landers, P.T., D.P.T.,O.C.S., CSCS says. “Using a knee extension machine is the most efficient exercise for strength training.” Ideally, strength training should occur three times per week.

Finding the correct weight to use can be difficult, but here are some helpful tips:

  • Set the weight to a challenging amount and attempt as many reps as possible.
  • Try to do a full set with both legs and then repeat the exercise with one leg.
  • If you can do more than 10 reps, add more weight and try again.
  • Repeat this process until the maximum number of reps you can complete is less than 10. This will be your starting weight.

 What comes next?

“Once you have built a base of quad strengthening throughout the first couple of months, work on training different aspects of strength, such as explosiveness and deceleration,” Landers says. Work on performing this quadriceps exercise at faster speeds or performing the lowering phase of the exercise more slowly. Ask for guidance from a strength and conditioning coach or physical therapist for other variations.
This training should be part of a comprehensive program for athletic readiness. Want to know how you can work with our team at Scottish Rite for Children? Read about our bridge program and sign up today!

Hydration Tips for Young Athletes

Hydration Tips for Young Athletes

by | Sep 19, 2022 | Sports Medicine

Our certified sports dietitian Taylor Morrison, M.S., R.D.N., CSSD, L.D., frequently teaches athletes that staying hydrated is an important part of staying healthy. She says, “Our bodies need water to replenish and refuel, especially after exercising or playing sports, and young athletes have different hydration needs than adults.” Each child or teen may have unique needs based on a variety of factors. Taylor shares key tips on how to help keep your young athlete hydrated and healthy.

  • Choose a fun water bottle. Try customizing with team stickers so it’s easy to identify on the sidelines.
  • Add high water content foods like oranges, cucumbers or yogurt to meals to make hydrating more fun.
  • Drink fluids throughout the day. Carry your water bottle or stop by the water fountain between classes.
  • Do not drink a large volume of fluid right before an event or physical activity.
    • This may not fully hydrate or rehydrate the athlete.
    • This may cause stomach discomfort or a trip to the restroom during the event.
  • Drink plenty of fluids during and after the event.
  • Learn what works for different activities.

How Much Fluid Does My Athlete Need?

Fluid needs vary based on age, gender, weight, and even genetics. For young athletes, other factors are just as important, such as stage of development, activity type, and the duration and intensity of activities. For some athletes, the amount of sweat or the composition of sweat may also affect how much and what type of fluid is needed. The below table shows a child’s or teen’s daily baseline fluid needs based on age and gender. Make sure to increase fluid intake above this when active or playing sports.

Hydration Strategy for Sports

Having a plan for staying hydrated is essential for young athletes playing sports or doing other physical activities. A hydration strategy is especially important for athletes who train in extreme temperatures or climates and participate in physical activities that last more than an hour. A good strategy for young athletes is to drink fluids before, during and after physical activity.

Before:
Drink fluids with and in-between meals and snacks throughout the day. Two to fours hours before physical activity, athletes should consume 2.3 to 4.5 milliliters per pound of body weight. This is the minimum amount of water your young athlete should be consuming in milliliters. A 12-ounce water bottle is about 350 milliliters, which is appropriate for pre-activity hydration for a 100-pound athlete.

During:
Athletes 9 to 12 years of age should drink three to eight ounces of fluids every 15 to 20 minutes. Athletes 13 to 18 years of age should drink 34 to 50 ounces of fluids every hour.

After:
Young athletes should drink fluids right after the event or physical activity, as well as with meals and snacks following the event.

When to Drink More Fluids

Special Conditions

Certain conditions can increase an athlete’s fluid needs. These conditions may increase sweat rates, alter the body’s ability to cool itself and increase the body’s core temperature:

  • Hot weather
  • Humidity
  • Altitude
  • Type of sport played
  • Length of activity
  • Clothing
  • Recent illness
  • Certain medications or supplements

More than Water

Water is the first choice for hydration but sometimes a sports drink or salty snack is necessary to replace sodium and other electrolytes lost through sweat and to provide energy from carbohydrates. After puberty, an athlete may sweat more, so replacing electrolytes becomes more important. Some salty snack ideas are sports drinks with six to eight percent carbohydrate, pretzels or salty crackers, cheese, pickles, or broth-based soup or vegetable juice.

A sports drink or salty snack may be needed for the following:

  • High intensity activities lasting longer than an hour
  • Tournaments and back-to-back events
  • Hot conditions, indoors or outdoors
  • Having salt on the skin or clothes after activity

Signs and Symptoms of Dehydration

If your young athlete is experiencing any of the following signs and symptoms, he or she may be dehydrated, and a hydration strategy may be needed.

  • Fatigue early in the game or practice
  • Decreased/poor performance
  • Headache
  • Muscle cramps
  • Overheating
  • Difficulty focusing
  • Urine that is dark in color, like apple juice
  • Low amount of urine

If you suspect that your young athlete is dehydrated, use our strategies above to rehydrate them. If your child is especially lethargic, a call to your medical provider may be in order.

Signs and Symptoms of Heat Illness

Heat illness is a preventable condition, and dehydration is an early sign of heat illness. Respond quickly if you notice any of the following signs of heat illness:

  • Weakness
  • Vomiting
  • Excessive thirst
  • Headache
  • Fatigue
  • Sweating
  • Nausea
  • Light-headedness
  • Confusion or disorientation

If your child is exhibiting one or more of the signs of heat illness, immediately call your medical provider for assistance to determine if treatment is needed. It is important that your young athlete knows these signs and symptoms so that they can recognize heat illness if they experience it.

Additional Support

With practice, a young athlete should learn what hydration strategy works best for training and competition. If you need help, reach out to a medical provider, the school’s athletic trainer or a certified sports dietitian for personalized recommendations.

Learn more about five strategies for keeping your young athlete fueled.

Learn more about hydration and nutrition for young athletes.