World-Renowned Hip Care

World-Renowned Hip Care

by | May 3, 2022 | General News, Hip Disorders

Scottish Rite for Children’s Center for Excellence in Hip has a long tradition of providing the highest-quality medical care to thousands of children, from newborns to adolescents and young adults. Led by director and pediatric orthopedic surgeon Harry Kim, M.D., M.S., the team provides a coordinated and comprehensive approach to care that brings together hip specialists from orthopedics, radiology, physical therapy, psychology and more. This multidisciplinary team approach allows us to offer a broad spectrum of operative and nonoperative care options to preserve, improve and repair the native hip joint. At the Forefront of Innovation  Our experts are committed to advancing clinically important research to provide the best care to our patients. Several of the center’s research projects have led to revolutionary, life-changing results. Patients who had evaluation and treatment at our center have the opportunity to participate in large patient registries to allow for evaluation of treatment outcomes for a variety of conditions. These studies lead to new insight and significant improvement as our team modifies treatment algorithms based on these results. In addition, doctors and researchers are involved in multicenter hip research groups with peers at top-tier institutions around the country. They regularly collaborate to discuss the latest innovations and treatment techniques regarding patients diagnosed with pediatric hip conditions and injuries. Movement Science Laboratory The accredited movement science laboratory is an integral part of the treatment of our patients. The multidisciplinary team of engineers and kinesiologists use leading-edge technology to evaluate and identify joint motion, net joint forces, muscle activity, strength, foot plantar pressures and oxygen consumption. These analyses guide the development of individualized treatment plans for our patients and support research. The clinical research team partners with movement science to study the changes experienced with surgical intervention to ensure each patient continues to maintain improved hip functions. Multidisciplinary Complex Hip Clinic This clinic brings all of our hip experts together in one clinic to review and evaluate each patient in person together. The history, physical examination and images are evaluated, and various options are discussed for treatment. The multidisciplinary approach also includes experts in the fields of physical therapy, psychology, pain management and nursing. A comprehensive diagnostic (if necessary) and treatment plan is then developed specifically for each patient. If surgical treatment is necessary, the full range of procedures are available with the experts in the field to include hip preservation surgery (both open and arthroscopic options) as well as the potential for utilizing total hip arthroplasty (replacement) when appropriate. This clinic occurs every month and only those patients requiring this multidisciplinary approach are included. Patients may request to be seen in this clinic. Hip Team All of our pediatric orthopedic surgeons are board certified in orthopedic surgery and also completed a fellowship in pediatric orthopedics. Several of our medical staff have a particular interest in treating and studying pediatric and adolescent hip conditions. Harry Kim, M.D., M.S. 
  • Special interest in treating patients with Perthes disease, adolescent and young adult avascular necrosis, and developmental dysplasia of the hip (a member of International Hip Dysplasia Institute).
  • Leader and chair of the International Perthes Study Group – multicenter research study focused on advancing the care of children diagnosed with Perthes disease.
  • Extensive basic and clinical research on Perthes disease and avascular necrosis.
Daniel J. Sucato, M.D., M.S. 
  • Special interest in treating adolescent patients with various hip conditions including hip dysplasia, adolescents and young adults with Perthes disease, slipped capital femoral epiphysis and femoroacetabular impingement.
  • A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study. A multi-center project that analyzes hip function and pain, quality of life and other factors on patients who undergo hip preservation surgeries.
Henry B. Ellis, M.D. 
  • Special interest in treating femoral acetabular impingement, labral tears and other sport-related injuries and conditions in the hip.
  • Involved in multi-center research projects with a special interest in hip arthroscopy.
  • A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study.
David A. Podeszwa, M.D. 
  • Special interest in treating patients with hip dysplasia, slipped capital femoral epiphysis and femoroacetabular impingement.
  • A member of the Academic Network of Conservational Hip Outcomes Research (ANCHOR) study.
William Z. Morris, M.D. 
  • Special interest in treating patients with hip dysplasia, slipped capital femoral epiphysis and femoroacetabular impingement.
  • Extensive clinical research in the pediatric and adolescent developing hip with expertise in the pathogenesis of slipped capital femoral epiphysis and femoroacetabular impingement.
Corey S. Gill, M.D. 
  • Special interest in treating infants with hip dysplasia and patients with cerebral palsy with various hip disorders/dysplasia.
  • Other common hip conditions seen include slipped capital femoral epiphysis, Perthes disease, transient synovitis of the hip, osteoid osteoma and proximal femur cysts.
Learn more about the Center for Excellence in Hip.
Pediatric Sports Neurology Perspective on Headaches and Migraines

Pediatric Sports Neurology Perspective on Headaches and Migraines

by | Apr 28, 2022 | Sports Medicine

Mathew Stokes, M.D., is a pediatric sports neurologist and headache specialist at UT Southwestern Medical Center and also sees patients at Scottish Rite for Children in Frisco. These resources are designed to help medical professionals recognize and manage sport-related concussions and headaches in children and adolescents.

Sports Neurology: Concussion and Headache in Young Athletes

Mathew Stokes, M.D.

Watch now

Stokes presented this lecture as part of a monthly education series for medical professionals. He described common symptoms including physical, emotional and cognitive changes associated with sport-related concussion. He presented risk factors associated with delayed recovery from concussion. Finally, he provided criteria for diagnosis, management and prevention of common headache types in athletes including migraines.

Non-Pharmacological Management of Migraines

Victor Kaytser, M.D., and Mathew Stokes, M.D.

Stokes, M.D., co-authored this article with UT Southwestern Medical Center neurology fellow, Victor Kaytser, M.D. The article was originally published in a recent newsletter of the Pediatric Society of Greater Dallas.

Download the PDF of this article.

What Is a Migraine and How Are They Treated?

Migraines are a common neurological disorder affecting one in 10 children, with a higher incidence in teenage girls. (Symptoms of migraine or what is not considered a migraine?)

As we learn more about migraines, we are finding new and innovative ways to treat them. This is especially important for patients who cannot take or do not respond well to the traditionally prescribed pain-relieving and preventive medications. In addition, parents may feel hesitant to medicate their children and will seek non-pharmacological remedies first. Therefore, we will discuss some non-pharmacological options for the treatment of migraines including lifestyle modifications, supplements and devices.

Lifestyle Modifications

Lifestyle modifications are recommended regardless of what other treatments may already be in place and can be remembered using the mnemonic SEEDS: Sleep, Exercise, Eat, Diary, Stress.

Sleep
Migraines can be caused by too much or not enough sleep, and disruptions in the normal 24-hour sleep cycle, or circadian rhythm. Poor sleep habits can trigger migraines, and migraines, in turn, make it difficult to sleep, further exacerbating the pain cycle. A few sleep hygiene tips are as follows:

  • Schedule a consistent sleep time and wake time, including weekends.
  • Do not use the bed/bedroom for other activities, such as studying, watching TV, etc.
  • Avoid staying in bed if wide awake; rise and do something else for a few minutes before trying to fall asleep again.
  • Take time outside to help set a natural circadian rhythm.
  • Do not exercise before sleep.
  • Avoid stimulants, such as caffeine or nicotine.

Exercise
At least 30 minutes of moderate-intensity exercise, three times per week can help reduce migraine frequency and severity. Patients should note that overexertion can worsen headaches. Those involved in contact sports need to be mindful that injuries and head trauma can also worsen headaches.

Eat
Both high and low blood sugar levels can affect migraines. Therefore, eating smaller meals, increasing protein, fiber and healthy fat intake while also reducing processed foods can help maintain healthy glucose levels and reduce migraine frequency.

Maintaining a caffeine-free diet is ideal; however, if patients currently consume caffeine, stopping the consumption suddenly can lead to caffeine-withdrawal headaches. Therefore, a slow weaning of caffeine products is recommended. Other foods that are commonly migraine triggers include aged cheese, chocolate and MSG.

Water intake is also important. The daily goal is one ounce per kilogram of body weight. (1 KG = 2.2 pounds)

Diary
A headache diary can help to identify migraine triggers. Triggers can vary from environmental (e.g., bright lights, weather changes) to nutrition, sleep changes or stressors. Identifying migraine triggers can help patients focus their lifestyle change efforts. Options include Migraine Buddy and iHeadache mobile apps.

Stress
To effectively manage stress, many turn to cognitive behavioral therapy, meditation, mindfulness, massages and yoga. There are free websites, like www.dawnbuse.com, that provide various relaxation audio files, articles and podcasts.

Supplements

Nutraceuticals
Riboflavin (vitamin B2), CoQ10, magnesium, curcumin and feverfew (Tanacetum parthenium) are the most commonly used for migraines. These nutraceuticals have positive effects on mitochondrial metabolism, antioxidant properties and are vasoconstrictors, helping to prevent or relieve pain in migraine sufferers. Several proprietary products, like Migrelief and Dolovent, combine these supplements in a single formula.

Magnesium acts as a calcium channel antagonist and has the most robust body of literature supporting its effects on migraine with a relatively low side effect profile (abdominal discomfort and diarrhea).

Therapies

Essential oils
Peppermint oil contains menthol, which can help ease pain by relaxing the muscles around the head. Rosemary oil has anti-inflammatory and pain-easing characteristics. Lavender and chamomile oil is used to help relax and reduce stress. Eucalyptus oil helps to open and clear the sinuses, which, if congested from allergies, may provoke headaches.

Heating and cooling pads
Placing a hot compress on the neck can help relax tense muscles and relieve pain. A cold compress or ice pack can provide relief through its numbing effect, temporarily dulling the sensation of pain when placed on the neck and/or forehead.

Acupuncture
Used for centuries to treat pain and manage stress, acupuncture has been shown to be at least as effective as some standard drugs like beta blockers and topiramate, and it is safer and more cost effective.

Devices

Medical devices like gammaCore, an external vagus nerve stimulator, can also help. The device is held against the skin of the neck and transmits small electrical currents to stimulate the vagus nerve and block pain signals. The device works in as little as 30 minutes, and 30% of patients were pain-free at two hours. About one-third of patients achieved a 50% reduction in headache frequency.

Nerivio is a neuromodulation device for patients 12 and older, worn on the upper arm to stimulate small nerves that send pain signals to the brain. A third of patients were completely pain-free at two hours.

Cefaly is an external trigeminal nerve stimulation device for patients 18 and older and does not need a prescription. The device is magnetically connected to a reusable self-adhesive electrode that is placed on the center of the forehead and sends micro-impulses to the trigeminal nerve. Studies reported that 32% of patients were pain-free at one hour, and 38% saw at least 50% reduction in migraines per month.

Allay Lamp emits a precise narrow band of green light that helps reduce the light sensitivity associated with migraine, which can also help reduce stress, anxiety and improve sleep.

Conclusion

Helping patients identify migraine triggers and follow daily headache hygiene tips can go a long way in composing an effective treatment plan. In some cases, lifestyle changes may be enough to reduce migraine frequency considerably and avoid the need for devices or medications all together. For others, a combination of lifestyle changes with a device, supplement or medication may be the most effective. For the latest migraine management tips, the American Migraine Foundation website routinely publishes new articles to better manage migraines.

Muscle Strain Q&A

Muscle Strain Q&A

by | Apr 22, 2022 | Sports Medicine

Our world-renowned sports medicine experts are ready to help your injured athlete get back in the game. We have unparalleled experience providing nonoperative and arthroscopic care to treat common sport-related injuries including concussions, ligament injuries and cartilage conditions in the knee, ankle, shoulder, elbow and hip in young and growing athletes.

Sports Medicine expert Jacob C. Jones, M.D., RMSK, shares information about muscle strains and how to handle these types of injuries in young athletes.

What is a muscle strain?
A muscle strain is a disruption of the muscle fibers in a certain muscle group. Muscle strains can be mild or they can be severe, causing muscle tearing.

What causes a muscle strain?
Muscles are constantly being pushed and pulled, but when a muscle contracts at the same time that it is being pulled, a strain can occur. This type of muscle movement is called an eccentric contraction. 

What are the symptoms of a muscle strain?
In mild strains or low-grade muscle disruptions, the most common symptom will be pain in the area. Severe disruptions or tears can also cause swelling, more noticeable weakness, and even bruising.

Should you seek medical treatment for a muscle strain?
It is definitely wise to seek medical treatment for muscle strains. In mild cases, a young athlete may want to consult with their athletic trainer for advice and recommendations on reducing the pain. Athletic trainers can also help determine whether the athlete needs to see a physician for the injury.

Relative rest, in combination with muscle rehab, is the best treatments for a strain. It is important to allow the muscle to heal while also building strength and flexibility to avoid further injury. Even in high grade muscle tears, surgery may not be commonly recommended. 

Are certain muscles more at risk for strains?
Yes, muscle groups that are at the highest risk for strains are those that cross multiple joints. For example, some hamstring and quadricep muscles cross both the hip and knee joints and calf muscles cross the ankle and knee joints. Any muscle can be strained, but those groups are more likely to be injured.

How can you avoid muscle strains?
Muscles are less likely to have a strain if they are flexible and strong. Stretching daily can help provide your muscles with more flexibility and strength. Additionally, it is important to also warm up your muscles before working out or playing a sport. Muscles are less likely to strain or tear when they are warm, so it is important to not skip warm-ups before practice.

What does recovery from a muscle strain look like?
Once pain allows, it is important to do some rehabilitation to the muscle before returning to regular activity. In mild strains or low-grade disruptions, recovery time may take weeks. In more severe cases that lead to muscle tears, recovery time may take months. We look for good range of motion, minimal to no pain, and good strength prior to return to sport.

What happens if an athlete returns to sports or activity before the strain is healed?
The biggest risk of returning to athletics or sports too soon is re-aggravating the muscle and extending the recovery time. Additionally, having a strain may cause you to favor one leg or arm and could lead to further injury.

How can ultrasound be used to diagnose and treat muscle strains?
Specially trained experts can use musculoskeletal ultrasound to evaluate injured joints, ligaments, tendons, muscles and bones. Ultrasound can visualize soft tissues like muscle well with a high level of detail. When looking at a muscle using ultrasound, a low-grade strain may show some edema, swelling caused by fluid in tissue, while a more severe strain that has already torn will clearly be visible. Using ultrasound can also allow physicians to determine where additional treatment or care is needed in treating muscle strains. Ultrasound can also be used for treatment of chronic muscle tears not improving with other conservative measures.

Sports medicine is a medical and surgical specialty that considers 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 Center for Excellence in Sports Medicine and how board-certified pediatricians, pediatric orthopedic surgeons, physical therapists, athletic trainers, psychologists and other sports medicine specialists work side-by-side with each athlete, their parents and coaches to develop the best game plan for treatment, rehabilitation and safe return to sport.

D Magazine: How Collin County’s Healthcare Providers Are Managing Record Population Growth

D Magazine: How Collin County’s Healthcare Providers Are Managing Record Population Growth

by | Apr 13, 2022 | Press Coverage, Sports Medicine

Collin County is the fourth-fastest growing county in the country. Growth can present all sorts of challenges for professionals working in education, healthcare, transportation and every other area of public life.

Philip L. Wilson, M.D., was part of a panel of Collin County leaders, talking about how their organizations met the challenge of keeping people healthy in the midst of a population explosion. 

Read the full article. 

Study Looks at Re-Injury Rate After ACL Reconstruction in Young Athletes

Study Looks at Re-Injury Rate After ACL Reconstruction in Young Athletes

by | Apr 12, 2022 | Dyslexia & Learning Disorders

Wrapping up his third year as a medical student at UT Southwestern Medical School, Craig Kemper, B.B.A., has participated in several projects with the Center for Excellence in Sports Medicine research team. Kemper was the lead author on a project looking at athletes who were back to sport after an anterior cruciate ligament (ACL) tear and reconstruction that was recently presented at the 39 annual meeting of the Mid-America Orthopaedic Association. The organization comprises orthopedic surgeons from 20 states, including Texas.

After surgery for the “primary” ACL tear, as many as 1 in 4 young athletes re-tear the reconstructed ACL or the ACL in the other knee. The rate for these “secondary” ACL tears in young athletes is a concern for researchers and clinicians in pediatric sports medicine. This review included patients seen over three years at Scottish Rite for Children for an ACL tear and reconstruction to determine whether participation in multiple sports protects against re-injury.

The 145 patients in the study were

  • an average age of 14 years.
  • 50% male, 50% female.
  • > 50% reported playing only one sport (single-sport athletes)
    • Most played soccer.
    • On average, these athletes returned to sports in fewer days than multi-sport athletes.

Kemper says young athletes continue to feel pressured to choose one sport at earlier ages to “not be left behind.” Many recommend multi-sport participation to help an athlete develop varied skills and protect from overuse injuries unique to growing children, including apophysitis and osteochondritis dissecans.

“We give this advice, but we aren’t sure if it applies to this population regarding re-injury after an ACL reconstruction,” says co-author and Medical Director of Clinical Research, Henry B. Ellis, M.D. “The time out of sports is already so long for an ACL tear, we are eager to learn all the variables that contribute to re-injury rates. Other studies have looked at surgical techniques, but this one looks at sport-participation and time to return-to-play.”

Although single-sport athletes were cleared to return to sports in a shorter time than multi-sport athletes, the analysis found no difference in the rate of secondary ACL injuries within two years of follow-up for this group. “Results like this are still helpful and give direction for future projects,” says Ellis. “More importantly, they help me as a pediatric orthopedic surgeon know how to counsel my patients.”

 

SINGLE-SPORT ATHLETES NOT EXPERIENCING INCREASE IN SECONDARY TEAR INCIDENCE DESPITE EARLIER CLEARANCE, Craig Kemper, B.B.A., K. John Wagner, III, B.S., Connor M. Carpenter, B.B.A., David E. Zimmerhanzel, B.S., Philip L. Wilson, M.D., Henry B. Ellis, M.D.

Learn more about ACL injuries on our website.