The Work Takes Time, But It Makes You Great

The Work Takes Time, But It Makes You Great

by | Jun 22, 2021 | Sports Medicine

18-year-old Caden has always loved baseball. He has been playing since he was 4 years old, and he’s received numerous awards through the years. When he was just 12, he was awarded Perfect Game’s Super25 MVP pitcher. As a teenager, he was included in Perfect Game’s All-Tournament Selection, Pre-Season All-American and All-Region teams. Caden plays second base mainly, but he has seen time at shortstop and center field. He is also a phenomenal, right-handed pitcher.
 
In 2018, Caden began to have pain in his right elbow, so he visited pediatric orthopedic surgeon Philip L. Wilson, M.D., at the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco. “I knew they had an excellent orthopedic program, and I was aware that Dr. Wilson had worked with many high-level athletes,” says Alan, Caden’s dad. “He is very well respected in elbows and shoulders.”
 
Wilson explained that Caden’s elbow pain and inflammation was caused by repeated stretching of the ulnar collateral ligament (UCL), a tight band of tissue on the middle side of the elbow, from throwing. There are two important components to treatment. First, the ligament needs time to heal, so rest from throwing and pitching is crucial. Then, properly timed rehabilitation focused on strength and flexibility of the shoulder and trunk helps the young athlete return to their pre-injury status. After his prescribed rest, he slowly returned to throwing with a strategic 8-week interval throwing program which gradually increases the quantity and distance of throws. The program also encouraged Caden to focus on proper form with every throw to reduce the risk of reinjury. “I was extremely pleased with Dr. Wilson’s entire staff,” says Caden.

Caden utilized additional resources in his recovery to further improve his flexibility and strength and to further reduce his risk of reinjury. Near his home in Rockwall, Caden completed formal physical therapy and a strength and conditioning program with practitioners knowledgeable in the shoulder and pitching programs. These programs helped build Caden’s strength, not only in his arm but in his core and back as well. “It’s not just one muscle – it’s a combination,” says Alan. “It’s getting everything working and firing together so he can handle the stress of pitching.” Physical therapy was humbling at first for Caden. “I saw charts with the average strength levels of collegiate and professional athletes compared to my strength level in high school and saw how long I had to go,” he says.

After six months of physical therapy, Caden was on the field with his teammates at Rockwall-Heath High School performing at the highest level. He was named 1st Team All-District for infield this season, and on June 12, he and his teammates won the UIL 6A High School State Championship. Caden was also named MVP of the game. Caden graduated high school this year and has received a scholarship to play baseball at Northern Oklahoma College in Tonkawa, OK.
 
Alan advises both young athletes and parents to pay attention to any inflammation and soreness that the child is feeling. “Always err on the side of caution and rest when you are dealing with pain,” he says. “If it’s not better after about a week, I recommend scheduling a consultation with Scottish Rite.” Wilson advises any athlete with activity-related pain to have an assessment by an athletic trainer or sports medicine specialist.
 
“Caden is a prime example of an athlete properly responding to pain. He rested, he rehabbed and he’s back at a very high level. If he had continued to throw, he might have ended up tearing the UCL and requiring a longer period out of baseball and possibly surgery. So many are concerned about missing a season, but he’s right – taking recovery seriously pays off in the end.“ – Philip L. Wilson, M.D.
 
Caden hopes his story can help other young athletes understand the recovery process so they won’t get frustrated when it seems like it is taking too long. “The steady work grind takes time, but it’s what makes you great too,” he says. “I think with shoulder care, it’s important to understand that stretching is not just a warm-up but truly a part of your overall pitching program.”

KRLD: The Human Side of Health Care

KRLD: The Human Side of Health Care

by | Jun 6, 2021 | Press Coverage, Spotlight

Over the past few months, members from our team have been invited as guests on The Human Side of Health Care – a weekly radio program hosted by the DFW Hospital Council that broadcasts on KRLD 1080 AM. 

Stacie Bukowsky, Director of Pharmacy at Scottish Rite for Children, discussed Scottish Rite’s ongoing efforts to provide opioid education, resources and support for patients and families. 

Listen to the full episode, Year 2 – Episode 23, June 6, 2021.  

Detecting and Treating Scoliosis

Detecting and Treating Scoliosis

by | Jun 3, 2021 | Scoliosis & Spine

Content included below was previously presented at the 2021 Pediatric Orthopedic Education Symposium by pediatric orthopedic surgeon Megan E. Johnson, M.D.

People hear the term scoliosis often, but they may not know what it means. Pediatric orthopedic surgeon Megan E. Johnson, M.D., walked through each phase of detecting and treating scoliosis in a recent lecture. This summary provides health care professionals with a succinct summary and language to navigate the steps and conversations with patients presenting with suspected scoliosis.

Watch the full lecture or download this summary

Defining scoliosis
Scoliosis is a structural lateral rotated curvature of the spine. For a condition to qualify as scoliosis, the Cobb angle, or the measurement of the degree of side-to-side spinal curvature, must be a minimum of 10 degrees. If the Cobb angle is less than 10 degrees, it is considered a spinal asymmetry, not scoliosis.

What are the types of scoliosis? 

  • Idiopathic scoliosis: The most common type of scoliosis. Idiopathic means that all other causes of scoliosis have been ruled out.
  • Congenital scoliosis: When vertebral malformations cause a curvature of the spine. The vertebrae weren’t formed correctly or haven’t separated from the other surrounding vertebrae correctly.
  • Neuromuscular and syndromic scoliosis: Occurs in patients with underlying neurologic disorders like cerebral palsy, spina bifida and other genetic conditions.

What age is scoliosis diagnosed?
Scoliosis may be diagnosed at any age, but earlier recognition often improves treatment options and outcomes. A patient’s age also helps to define the type of scoliosis that they may have.

  • Infantile idiopathic scoliosis: patient is between 0 and 3 years old at the time of diagnosis.
  • Juvenile idiopathic scoliosis: patient is between 4 and 9 years old at the time of diagnosis.
  • Adolescent idiopathic scoliosis: patient is 10 years or older at the time of diagnosis.

The most common type is adolescent idiopathic scoliosis (AIS). The patient’s curve typically goes to the right and can include either the thoracic or lumbar spine or both.

What history and physical exam findings are important with scoliosis?
In order to evaluate patients, it is important to learn if patients have had back pain, headaches, other neurologic symptoms or a family history of scoliosis. For girls, it is also necessary to know their menstrual history to gauge where they are in their growth cycle.

The physical exam is focused on identifying asymmetries in static posture. This includes:

  • Differences in shoulder height.
  • Scapular asymmetry – scapulae are at different heights or one is more retracted.
  • Pelvic obliquity – iliac crests are at different heights.
  • Trunk shift – drawing an imaginary line from the patient’s head to their waist and seeing if the head is centered over their waist.
  • Waist asymmetry – a visible bulge (typically on left) on the convex side of a lumbar curve, and crease on the concave side of the curve.

Special test
A very common test for scoliosis that most people are familiar with is the Adams forward bend test. Patients bend forward at the waist, and the examiner looks for signs of rotational deformities. Curves in the coronal plane cause rotation in the axial plane, which are visible in the Adams test. For example, a left midline lumbar prominence and the prominence of the right ribs are evident with a right thoracic curve.

Neurologic exam
A thorough neurologic exam assesses for asymmetries and changes in sensation, reflexes and motor function in the trunk and lower extremities. The patellar tendon, the Achilles tendon and the abdomen are tested to look for symmetry in reflexes. Being hyper-reflexive is fine when it is present on both sides. If there are reflexes on one side and not the other, it is an abnormal finding. Foot abnormalities, like a cavovarus foot or a significant flat foot on just one side, may indicate an underlying neurologic concern.

What radiologic imaging is used to diagnose scoliosis?
Plain film radiology (X-rays)
X-rays are essential to assess the patient’s scoliosis. Full-length X-rays of the spine, including the pelvis and the top parts of the hips and femurs, will give physicians all the information that they need to determine what the curve looks like, how big the curves are and how much growth the patient has left. Full-length X-rays are necessary for final diagnosis and treatment planning. Scottish Rite for Children uses advanced imaging technology called EOS, which utilizes a very-low-dose radiation for efficient and effective full-length images. To avoid unnecessarily repeating X-rays, images are not required for referrals for suspected scoliosis.

Advanced imaging
An MRI is indicated with these findings:

  • Curve abnormalities like a left-sided curve, a back that is rounder than expected or an abnormal appearing curve.
  • Short and sharp curves and kyphosis are red flags requiring further evaluation with an MRI.
  • Abnormal neurologic exam or other neurologic symptoms, like daily headaches.
  • Significant progression in the patient’s curve between follow-up appointments.

What factors are considered in planning treatment for scoliosis?
The goal of scoliosis treatment is to keep the spinal curve(s) as small as possible and prevent progression to surgery. The following are considered:

  • Age of the patient.
  • How skeletally mature they are.
  • Size of the scoliosis curve(s).

Bracing
Bracing is recommended for patients with curves between 20-25 and 40 degrees if they have at least two years of growth remaining. Thoracic lumbar sacral orthosis (TLSO) braces are worn 18 to 20 hours a day and are typically used for curves in the thoracic spine or both the thoracic and lumbar spine. If the patient only has a lumbar curve that is flexible, nighttime bracing may be recommended.

Surgery
Surgery is recommended when the patient’s curve has a Cobb angle of 50 degrees or more to prevent the curve from progressing into adulthood. Surgery is generally not recommended until the patient is at least 10 years old because if the fusion is done too early, the growth of the patient’s spine can cause some secondary issues.

When should a patient with suspected scoliosis see a pediatric orthopedic specialist?
Patients should be referred to Scottish Rite for Children:

  • If they have a scoliosis curve and are still skeletally immature.
  • If they are fully grown with a significant deformity that is visible in the clinical exam.
  • If they have a scoliosis curve with an abnormal neurological exam, chronic back pain, daily headaches, an asymmetric foot deformity or any other unusual symptoms.

Many patients evaluated at Scottish Rite for Children do not have scoliosis, but our team provides reassurance and recommendations for monitoring over time. Annual or six-month observation visits are indicated for some patients since curves change as the patient grows.

Are you interested in learning more? Visit our on-demand page for more educational opportunities including scoliosis and orthopedic topics.

Dallas Morning News: Scottish Rite for Children offers premier scoliosis treatment for pediatric patients

Dallas Morning News: Scottish Rite for Children offers premier scoliosis treatment for pediatric patients

by | May 26, 2021 | Centennial, Press Coverage

Scottish Rite for Children has dedicated the past 100 years to improving the care of children worldwide, offering premier scoliosis treatment for pediatric patients. 

An estimated 9 million school-age youth in the U.S. are affected by scoliosis. At Scottish Rite, researchers in the Sarah M. and Charles E. Seay Center for Musculoskeletal Research are hard at work studying the causes of scoliosis. 

Read more about how Scottish Rite is changing the trajectory for a boundless childhood, with specialized expert care made specifically for growing kids.  

A Soccer Injury Won’t Slow This MVP Down for Long

A Soccer Injury Won’t Slow This MVP Down for Long

by | May 25, 2021 | Sports Medicine

During a soccer game this spring, 14-year-old “Coppell FC” midfielder, Thomas, blocked a shot and fell to the ground. His father, Michael, didn’t think too much of it. Thomas often puts his body on the line to make shots and blocks, and most of the time, he quickly bounces up and continues to play. “When he didn’t get up, I realized that something was different,” says Michael. “We hit the ball on opposite sides at the exact same time, so that twisted my knee, and I heard a pop,” says Thomas recalling the play. Michael ran to Thomas on the field and could see that his knee was already swelling.

The family had taken their children to the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco for other injuries in the past, so Michael knew who to call. Thomas was examined by sports medicine physician Shane M. Miller, M.D. The X-ray and MRI confirmed that the “pop”, immediate pain and swelling were caused by the tearing of the medial patellofemoral ligament (MPFL) when his kneecap temporarily dislocated. This ligament helps to prevent the kneecap from slipping to the outside of the knee.

While going over nonoperative and operative treatment options, Miller informed them that without surgery, there was a 50% to 80% chance that his kneecap would dislocate again while participating in sports. They decided to meet with pediatric orthopedic surgeon Philip L. Wilson, M.D., who reassured them that surgery was the best option for long-term recovery and healing. A couple of weeks later, Wilson and certified pediatric nurse practitioner Chuck W. Wyatt, R.N., M.S., CPNP, RNFA, performed an MPFL reconstruction. “Dr. Wilson and his team did a great job!” says Michael. Thomas was happy too and says, “Dr. Wilson was very nice, and so were all the people who helped me, like Dr. Kelly who helped with my IV and pain medication.”

Ten days after surgery, Thomas started twice a week physical therapy at Scottish Rite with physical therapists, Madelyn “Maddie” White, P.T., D.P.T., and Rushi Patel, P.T., D.P.T. He and his father are very pleased with the progress. “Physical therapy has been great!” says Thomas. “Maddie and Rushi are both great. Right now, therapy includes mostly basic exercises, but I can now bend my knee past 90 degrees. I started at like 70 degrees, which is pretty bad, so it’s improving.” Maddie agrees, Thomas is improving. She says, “After most surgeries, the first stage of rehabilitation is to protect and regain motion in the joint. Soon, Thomas will progress to exercises and activities that will improve strength and control in his legs and trunk.”

In addition to soccer, Thomas also plays baseball. His previous experience with physical therapy at Scottish Rite was for Little Leaguer’s shoulder, which helped him to commit quickly and fully trust in the postoperative rehabilitation plan. Thomas will miss this year’s baseball season and playing in one of his favorite events, Middle School Matchup (MSM) Summer Smash. As a Scottish Rite patient and alumni of the MSM, Thomas was invited to throw out the opening pitch for the 2021 tournament. It’s no surprise that Thomas loves this event. The fun-focused tournament brings together unlikely baseball and softball teams formed through middle school affiliations, reminiscent of sandlot play where skill isn’t a deciding factor.

 

Thomas is very focused on what he can do instead of what he can’t. Thomas is looking forward to trying out for the soccer team his freshman year at Coppell High School. “I’m doing a lot better,” says Thomas. “I’m walking without crutches, and hopefully, the brace will be off my leg soon.” He is already thinking ahead about exercises that he can do once the brace comes off to strengthen the muscles around his knee to help reduce the chances of reinjury. As he heals and progresses in rehabilitation stages, his physical therapists will introduce exercises that include more functional and soccer-specific movements. When he completes his formal physical therapy, Thomas will be a good candidate for our bridge program, designed to progress the patient back to sports safely.

Thomas encourages young athletes to stick with physical therapy and to do what their trainers say. “They know what is best,” he says. “You want to be back on the field as soon as possible, and if that means taking things slow now, it’s worth it in the long run.” Michael wants parents of young athletes to know that it is hard when your child is taken out of the sport that they love because of an injury. It hurts to see your child in pain, but he says it is important to have a positive attitude and to work closely with your medical team. 

 

“Their advice is the best we can get, so open communication with your medical team is going to help your child make progress,” says Michael. “With Scottish Rite’s help, Thomas is getting better every day. Not just physically, but emotionally and mentally too.”