Diagnosing, Referring and Treating Newborns with DDH

Diagnosing, Referring and Treating Newborns with DDH

by | Aug 18, 2022 | Hip Disorders

Watch the lecture on YouTube or read this summary to catch the highlights.

Download the PDF.

This is a summary of a presentation for medical professionals that focuses on developmental dysplasia of the hip, or DDH. Presented by William Z. Morris, M.D., the seminar dives into everything medical professionals need to know about evaluating and treating DDH in newborns, helping physicians recognize the condition and respond earlier.

DDH is a common condition that occurs in about one in 100 infants. The condition is characterized by a shallow acetabulum and/or under-covered femoral head in the hip. It can occur due to a malformation of anatomic structures that have developed normally during the embryonic period and ranges in severity from physiologic immaturity to subluxation to frank dislocation. The presentation covers the epidemiology of DDH and its risk factors.

Dr. Morris provides updated guidelines for selective ultrasound screening for high-risk infants and includes data from his recent publications and presentations at national conferences. The presentation covered a full DDH screening and physical exam, showing providers exactly how to look for signs of DDH in newborns. He explains that physical findings fall on a spectrum and vary with the severity of the pathology and the age of the child. The presentation includes a detailed video of a newborn physical exam, showing participants hip-specific tests that can be performed to identify even subtle signs of dysplasia.

Email medicalprofessionals@tsrh.org to request access to the full exam video.

Imaging is a valuable tool in helping to diagnose DDH, but Dr. Morris shares why it is best to wait until the patient is 6 to 8 weeks of age in cases of screening ultrasounds for stable hips,  using facts and figures to illustrate this reasoning. He recommends ultrasounds at 6 to 8 weeks of age, which reduces false positive rate, and X-rays after 6 months of age once the hip has undergone sufficient ossification.

The presentation continues with Dr. Morris describing treatment protocols for DDH. For many, primary treatment for DDH begins with a Pavlik harness for six to eight weeks. He shares what to watch for with this treatment and its success rate using granular data in order to arm primary care physicians with data that can be used to reassure families once the diagnosis is made. He then talks about further treatments, including hip abduction brace, closed or open reductions and spica cast, and in which cases each may be used.

Finally, Dr. Morris shares vital information about DDH prevention, such as healthy hip swaddling, the use of proper sleep sacks and the correct use of baby carriers and how each of these can contribute to DDH in newborns.
Dr. Morris encourages physicians to refer patients early and often in cases of suspected DDH, know the risk factors and help parents with prevention techniques. He stresses that in most cases, nonoperative treatment is very successful, especially when the condition is caught early. Pediatric physicians and their patients can greatly benefit from Dr. Morris’ expertise with DDH, learning everything physicians need to know to provide their smallest patients with the best care.

With Her Knees Back in Sync, Abbee’s Ready to Take It From the Top!

With Her Knees Back in Sync, Abbee’s Ready to Take It From the Top!

by | Aug 18, 2022 | General News, Sports Medicine

A woman in a green jumpsuit is dancing on a stage .

Abbee, age 16 of Denton, isn’t like most kids her age. She attends a unique online school just so that she can devote as much time as possible to her true passion – dancing. She is dedicated, spending more than 40 hours a week practicing her dance, earning an invitation to participate in an exclusive pre-professional program at The Joffrey Ballet School.

Abbee dances all day, every day and is determined to pursue a career as a professional dancer. “I knew from a young age that this is what I wanted to do forever,” she says. When Abbee began noticing that her knees were “buckling” while she was dancing, she knew something was wrong. “It would happen while I was dancing, and it would take me out of dance for a few days until the pain went away,” Abbee says. “Eventually, it was happening so often that we decided it was time to see a doctor.”

Abbee visited our Sports Medicine clinic in Frisco to see Jane S. Chung, M.D., pediatric sports medicine physician for Scottish Rite for Children who has a passion for caring for female athletes and dancers. After discussing her history, performing a physical exam and reviewing X-rays and an MRI, Dr. Chung explained that Abbee’s kneecaps sit higher than normal. This position of the kneecap is referred to as patella alta and it can cause patellar instability or patellar subluxation, which is a partial dislocation of her kneecap. Chung reviewed the treatment options, ranging from physical therapy (PT) to surgery. As many patients do, Abbee chose a nonoperative approach first. She began PT to strengthen the muscles in her knees right away, working with physical therapist Jessica Dabis, P.T., D.P.T., O.C.S., to complete exercises to reduce the frequency and hopefully prevent dislocations. After completing PT, Abbee returned to her rigorous dance schedule, and she noticed that her knees felt much stronger.

Abbee visited with pediatric sports medicine surgeon Philip L. Wilson, M.D., and pediatric orthopedic nurse practitioner Chuck Wyatt, M.S., CPNP, RNFA,  who described the procedure and recovery and put her at ease. In November 2021, Wilson reconstructed the torn MPFL, which also corrected her patella alta. This procedure should prevent the instability episodes in this knee. Abbee began PT with Jessica Dabis at Scottish Rite again to rehab her left knee following surgery, working to get back to dancing

Soon after her surgery, Wyatt and Wilson determined that Abbee’s right knee also had a torn MPFL. Abbee knew this meant she would likely need another surgery, but she wasn’t worried. “I was already going to be out for this entire dance season, why not just get them both done and be completely healthy?” Abbee says. She continued PT of her left knee while preparing for surgery for her right knee, just 59 days after her first surgery. After surgery, Abbee was extremely diligent about her rehabilitation, following every instruction.

A woman in a green leotard is standing on one leg on a stage .

She continued PT through July 2022, strengthening the muscles in her knees and following her therapist’s prescribed dance-specific rehabilitation progression. This included a step-by-step return to dance skills and movements, building up from modified to full-out participation. She’s now back to doing what she loves most, dancing, and is so thankful for the team at Scottish Rite for helping her get where she needs to be. 

“Having two back-to-back knee surgeries before the age of 16 is never something I imagined for myself,” Abbee says. “But now I am so extremely proud of myself for making that difficult decision because now I can go back into dance confidently knowing that my knees will be better. I won’t have that fear that my knees will partially dislocate. This entire experience at Scottish Rite has truly changed my life for the better, and I couldn’t have asked for a better team and medical care.”

WE ENJOY HEARING ABOUT OUR CURRENT AND FORMER PATIENTS’ SUCCESS STORIES. TELL US ABOUT YOUR MVP. 

Ten Ways To Manage Pain Without Medication

Ten Ways To Manage Pain Without Medication

by | Aug 15, 2022 | Psychology

Whether following an injury or a surgery, pain management is an important factor in many orthopedic conditions. Our psychology experts provide our patients with the necessary techniques and skills to manage their pain, preventing the need for extensive medications. Much of pain management is based on mental perception. Pediatric psychologists Emily Gale, Ph.D., L.P., ABPP, and Emily Stapleton, Psy.D., explain how to manage pain using psychology.
 
Importance of Pain Management
 
Nobody wants to be in pain, and ongoing or chronic pain can lead to mental health issues, such as anxiety and depression. Pain management is important to prevent increased stress levels and improve comfort in daily life. “Non-pharmacological pain management interventions are important because they allow patients to increase comfort for continued function, therefore supporting overall quality of life and allowing them to stay involved in the activities and sports they love,” Stapleton says. “Individuals who use these strategies also tend to rely on medications less, thus experiencing fewer side effects, decreased drug dependency and have reduced health care costs.”

Emotions and Pain Management
 
Our emotions and behaviors can directly impact our perception of pain. “The experience of pain is a multifactorial experience in our brains — multiple centers, including the limbic system, which is involved in emotional processing, help us understand pain,” Gale says. “In fact, the International Association for the Study of Pain defines pain as ‘an unpleasant sensory and emotional experience associated with, or resembling that associated with, actual or potential tissue damage.’ Therefore, emotion management is a critical part of managing pain. Specifically, negative emotions often amplify the intensity of pain while positive coping skills can mediate the experience of pain.” Different psychology methods can allow patients to regulate their emotions and work through painful situations.
 
Pain Management Techniques
 
Our team of experts have many tips to help patients cope with pain. The following techniques can help manage pain:
 

  • Eat healthy meals at regular times throughout the day.
  • Be sure to get plenty of sleep to refuel your body.
  • Stay active and exercise regularly.
  • Address any concerns with mood (i.e. poor mood, irritability).
  • Use skills such as:
    • diaphragmatic breathing
    • progressive muscle relaxation
    • guided imagery
    • positive self-talk
    • stress management

 
Diaphragmatic Breathing
Diaphragmatic (belly) breathing is a technique that strengthens the diaphragm while deeply breathing.

  • Use the diaphragm and expand your belly instead of the upper chest muscles.
  • Diaphragmatic breathing can help you relax, breathe more easily and strengthen your diaphragm.

Diaphragmatic breathing does not take the place of medicines or other treatments, but it can help you breathe more easily in certain situations. Learn how to use diaphragmatic breathing in our Pain Management Workbook.
 
Progressive Muscle Relaxation
Progressive muscle relaxation (PMR) or “Tense and Relax” is the simple practice of tensing, or tightening, one muscle group at a time followed by a relaxation and release of tension in that muscle group. Practicing this skill helps you get better at recognizing and reducing tension in your body and decreasing stress, anxiety and discomfort. PMR practice allows the muscles to relax more thoroughly after releasing, which makes letting go of physical tension more effective and increases relaxation.
 
Guided Imagery
Imagining a relaxing place or thinking relaxing thoughts can reduce pain and decrease stress. You can use imagery to imagine you’re somewhere else as a distraction from your pain and to feel more relaxed.
 
Positive Self-Talk
Self-talk is the inner voice or internal conversation that we have with ourselves. The way you talk to yourself can have a big influence on how you feel and act. Negative thoughts or self-talk increases stress, so with practice, you can learn to shift negative thoughts to positive ones and decrease stress using this cognitive-behavioral technique.
 
Learn more about the skills and psychology approaches used to manage pain in our Pain Management Workbook to assist patients and others with managing their pain. Download it now to get started. Learn more about our Psychology services.

Forbes Health: Scoliosis: Symptoms, Treatments, Mental Health Affects And More

Forbes Health: Scoliosis: Symptoms, Treatments, Mental Health Affects And More

by | Aug 15, 2022 | Press Coverage, Scoliosis & Spine

Scoliosis is a spine condition that affects approximately 2% to 3% of the global population, according to the American Association of Neurological Surgeons. Whether you have scoliosis yourself or know someone who does, read on to learn more about the condition, its types and causes, common symptoms and treatments, how it can affect mental health and more.

Read the entire article.

Fear-Avoidance in Athletes

Fear-Avoidance in Athletes

by | Aug 9, 2022 | Psychology

What is Fear-Avoidance?

Athletes who experience an injury often struggle with fear-avoidance once they are physically cleared to return to sports. Out of fear of pain or injury, fear-avoidance is when a person develops and maintains chronic pain due to avoiding certain motions or behaviors. “Fear-avoidance is a model that describes how movement and pain-related fear can impact the development and maintenance of chronic pain and increased sensitivity to pain,” pediatric psychologist Emily Stapleton, Psy.D., says. To avoid perceived pain or injury, athletes may believe they cannot complete some rehabilitation exercises and as a result, the athlete may:

  • hesitate when completing exercises
  • not put in effort
  • hold back in training or competition
  • increase their dependency on family, coaches or medical team

The more the athlete does these things, the greater the anxiety becomes about pain, movement and reinjury. This fear-avoidance cycle is shown below:

What Does Fear-Avoidance Look Like in the Athlete?

“In athletes, fear-avoidance may look like hesitation when completing necessary exercises for recovery or decreased effort in rehabilitation exercises,” Stapleton says. “You may also see athletes skipping certain physical therapy exercises, discontinuing exercises early, or not completing the number of reps or recommended time due to pain or pain-related fear. Outside of rehabilitation, athletes may avoid social activities or sports where they anticipate the need to engage in increased physical activity, or actions they perceive as unsafe or as likely to increase pain, such as walking long distances or standing for extended periods of time.”

Part of the fear-avoidance cycle includes catastrophizing, or assuming that the worst possible outcome or event will happen. “This pattern of thinking increases distress and is linked to both anxiety and depression,” Stapleton says. In athletes, catastrophizing can manifest in many ways:

  • Constant or invasive thoughts about the pain of injury.
  • The athlete might think their injury is the worst possible injury and that they will never get back to their pre-injury performance level.
  • Believe nothing can be done about their pain or injury, and they will never recover.

This negative thinking can lead to fear of pain, movement, further injury and result in avoidance of anything that might cause pain, make the injury worse or result in another injury. As a result of increased anxiety and avoidance, one can become fixated on monitoring physical sensations in their body and very sensitive toward anything that increases discomfort, even physical therapy exercises that are needed for recovery. This often leads to sedentary behavior and will stop or greatly reduce physical activity levels. “Avoidant behavior is expected and healthy in the immediate acute phase post-injury, as following injury rest is often needed for recovery,” Stapleton says. “However, when returning to activities is appropriate or engagement in physical therapy exercises is necessary to recovery and rehabilitation, avoidance of these activities can actually be harmful, leading to increased pain, chronic pain, and/or declines in mood.”

In athletes, deconditioning often triggers more negative thoughts about their abilities, which can lead to depression and disability. Concerning signs and symptoms of depression include:

  • changes in appetite
  • changes in sleep
  • irritability
  • anger
  • sadness
  • frequent crying or emotional outbursts
  • lack of motivation, a decline in academic performance
  • disengagement and/or social withdrawal
  • substance abuse

It is important to learn strategies to cope with the anxiety so that rehabilitation and recovery are not significantly impacted.

How to Provide Support
There are ways that you can help support your child and work through their range of emotions and fears:

  • Help them to identify exercises or activities that increase negative emotions, or triggers. Look for when an athlete becomes distressed, avoids or hesitates prior to certain exercises for clues of triggering activities/exercises.
  • Create a hierarchy of the identified triggers and rate them from least to most fearful.
  • Start with the least feared exercise and have the athlete perform the task in a controlled and safe environment. Challenge the athlete to increase speed, repetitions and/or difficulty until they are performing without worry.
  • Use goal-setting techniques, such as setting SMART goals (specific, measurable, attainable, relevant and timely), to create daily, weekly and monthly goals for building tools to manage anxiety and stress, as well as to do the identified fear exercises.
  • Build coping skills to handle fear and worry triggered by pain and movement. Diaphragmatic breathing, positive self-talk and imagery techniques have all been shown to help reduce levels of distress, increase comfort and build confidence during rehabilitation and return to sport.
  • Provide education about how fear and decreased confidence can increase their pain and get in the way of their ability to return to their sport.

Learn more and download tips for helping young athletes manage stress.

Psychology Services at Scottish Rite for Children
Our Psychology department has teams of pediatric psychologists at both our Dallas and Frisco campuses. Pediatric psychologists are embedded in the care of each patient, providing support to our sports medicine patients throughout their care and treatment. Learn more about our psychology services.

Emily Stapleton, Psy.D., is a pediatric psychologist at the Frisco campus of Scottish Rite for Children. She specializes in pain management, rehabilitation, coping with acute and chronic illness/injury and sports medicine. She has a particular interest in supporting young athletes following a sport-related injury.