Surmounting Setback Through Strength

Surmounting Setback Through Strength

Published in Rite Up, 2023 – Issue 2. 
 
Running intensely down the long runway, Lawrence launched into a roundoff, followed by five no-handed back handsprings and then a back handspring into a double pike. Landing sharply on the mat with all of the pressure on her ankles, she fell to the ground. “I was in terrible pain, and I just remember paramedics coming over,” says 16-year-old Lawrence, of Richardson. That day in June of 2022, Lawrence broke both of her ankles at the USA Gymnastics® Championships in the trampoline and tumbling event in Des Moines, Iowa. “I was really scared that I wouldn’t be able to tumble anymore,” she says.

A girl doing a handstand in front of a sign that says gymnastics

An elite power tumbler, Lawrence has been a gymnast since she was 5. “I would flip all around the house,” Lawrence says. “I’d flip off the couch, make up routines on my bed and outside with my friends at recess. I’ve always had a passion for it.”
 
After a trip to the emergency room in Des Moines, Lawrence and her family decided to wait until they got back to Dallas to have surgery. “It was the longest car ride ever,” says Hollis, Lawrence’s mother, “but I knew the wonderful reputation of Scottish Rite for Children because I used to work there as a physical therapist, and I had heard that Dr. Ellis was the person we needed to see.”

A few days later, Lawrence found herself in the care of pediatric orthopedic sports medicine surgeon and medical director of clinical research Henry B. Ellis, M.D., and a multidisciplinary team of experts at the Scottish Rite for Children Orthopedic and Sports Medicine Center in Frisco. After having surgery on both ankles, Lawrence underwent a treatment plan that included having splints on both legs and then successively wearing casts, boots and braces before she could walk without aid. For many weeks, she was in a wheelchair until she could use crutches. “The lack of things I could do made me feel pretty hopeless,” Lawrence says. “I stayed in bed all day. I couldn’t do anything on my own, even go to the bathroom or take a shower.”

During her visits at Scottish Rite, Lawrence received a continuum of care in body, mind and spirit, including support from physician assistant Ben Johnson, P.A.-C., A.T.C., pediatric nurse practitioner Heather Barnes, D.N.P., child life specialist Marissa Willis, CCLS, and pediatric psychologist Emily Stapleton, Psy.D. “Dr. Stapleton talked to me every visit about how I was feeling mentally, which I didn’t take into consideration before the injury,” Lawrence says. “I thought I’d just be lying in bed, and then I’d get up and be fine, but it was a lot harder than I expected mentally. She really helped me discover things that I like to do besides tumbling, like reading and doing crafts.”

Hollis says that for her as a parent, Scottish Rite for Children means trust. “I totally and completely trust the doctors, nurses, support staff and therapists,” Hollis says. “Once we were in the hands of Scottish Rite, I knew Lawrence would be okay.”

A woman stands in front of a green wall with her arms crossed

After a few months, Lawrence started walking and began the recovery process. “I was so excited to get strong, work out and do normal things that I took for granted like walking with my friends,” Lawrence says. “It might take a village to get elite athletes back after a bad injury,” Dr. Ellis says, “but the truth is that it takes a special patient with resilience, strength — both mental and physical — and perseverance.”
 
Today, Lawrence is back in the gym taking power tumbling classes and learning a new specialization called acrobatics and tumbling, a sport that combines gymnastics and the athletic aspects of competitive cheerleading. She takes private lessons from Hope Bravo, the 2019 U.S. tumbling bronze medalist who also competed in the Acrobatics and Tumbling program at Baylor® University. Lawrence says that Baylor’s program is the best, and she aspires to join the team when she graduates from high school. “

The care I received at Scottish Rite was amazing,” Lawrence says. “Though the injury set me back and that was really difficult, I’m glad I am where I am now because I didn’t think that would be possible. I love what I’m doing now. I have new goals, and I’m happier than I’ve ever been.”
 
Read the full issue.

One-of-a-Kind Program Teaches Pediatric Fundamentals in Musculoskeletal Ultrasound

One-of-a-Kind Program Teaches Pediatric Fundamentals in Musculoskeletal Ultrasound

The use of musculoskeletal ultrasound (MSK US) is becoming increasingly popular and a point of emphasis in trainee education; however, most training programs focus on conditions in adults. Scottish Rite for Children experts have developed an introductory program to help new users learn about the unique skills and applications in the pediatric setting.

After a successful inaugural course in 2022, Scottish Rite hosted a second MSK US program. The feedback continues to show that we have a unique conference, and we plan to continue offering the program regularly.

This interactive, hands-on program features faculty from a variety of pediatric subspecialities including radiology, rheumatology and sports medicine. Attendees traveled to Frisco, Texas from across the country and internationally with a variety of clinical certifications including physical therapists, sonographers, nurse practitioners, physicians as well as radiology administrators.

Staff were encouraged to hear that all attendees indicated they were “very likely” or “definitely” going to recommend this course to others. Asked about the best part of the program, attendees’ responses are indicative of what future participants should expect:

  • All the hands-on activities intermixed with patient lecture beforehand; the teachers were incredibly kind.
  • Having pediatric patients!! Variety of faculty. Loved having MDS, RMSK, US Sonographer and radiologists. Truly a fantastic course.
  • Short lectures alternating with hands-on
  • Hands-on practice in SMALL groups with EXPERIENCED mentors.
  • It was so helpful having pediatric models – I really learned a lot from the hands-on sessions!
  • Multi-modal approach to learning
  • The dual hands-on and lecture content kept my mind and body awake and elevated the overall learning experience!

Jacob C. Jones, M.D., RMSK, says, “The program is intended to offer an introduction to ultrasound basics including settings, scanning and injection techniques focused on skeletally immature patients.” Throughout the day, more than 20 children and teens ranging from 5 to 19 shared their time with our learners.

After a lecture introducing scanning for rheumatologic conditions, participants observed and practiced scanning patients with active joint inflammation. Nurse practitioner Heather Benham, D.N.P., APRN, CPNP-PC, RhMSUS explains, “We are grateful for these patients and the other children volunteers who make this course so special. It is very difficult to teach these principles when scanning healthy joints.”

During one scanning session, Scottish Rite sonographer Kelly Sherrard, RDMS, demonstrated the techniques of evaluating newborns for developmental dysplasia of the hips. Three-month-old twins served as our models for this exciting addition to the program. The expertise required for this population makes it difficult to include this training in the program, but attendees expressed their appreciation for the demonstration and the complexity of the skill.

Join the email list so you can gain early access to registration for future courses. Our next program is being planned for November 2023.

Sports Medicine Research Featured at National Meeting

Sports Medicine Research Featured at National Meeting

Several of our physicians and trainees attended the American Medical Society for Sports Medicine (AMSSM) annual meeting recently. At this event, individuals are selected to share progress and results on projects that impact the care of athletes of all ages. Our team shared several pediatric-focused studies. Additionally, Jane S. Chung, M.D., served as faculty for a pre-conference event teaching participants how to transform a clinical question into a successful research project. Each of these activities reflects our organization’s commitment to provide the best care, continued learning and teaching through research and academic endeavors. Here are several projects our Center for Excellence in Sports Medicine research team, and trainees, extensions of our team, presented at this meeting.

AMSSM Grant-Funded Project Presented by Lead Investigator
Jane S. Chung, M.D., is conducting a study with the Movement Science Lab team to evaluate movement in pediatric ballet dancers. The larger project includes evaluating demographics, surveys and movement data to determine how ballet dancers respond to training demands of the art. The project presented at this event is titled, “Athletic identity and Injury Patterns in Pediatric Ballet Dancers,” and began to explain how ballet dancers think about their identity as an athlete and found that pediatric ballet dancers, particularly those who trained more and reported a prior history of injury strongly identify with their sport.

 

The purpose of the AMSSM Foundation Research Grant Award program is to foster original scientific investigations by members of AMSSM. Research proposals that investigate issues within the broad discipline of sports medicine will be considered, including clinical practice, injury prevention and rehabilitation, basic science, epidemiology and education. – 

Sport-Related Concussion Projects Presented by Trainees
David Mikhail, B.S., is a medical student at UT Southwestern Medical Center who presented “A Longitudinal Evaluation of Differences Between First and Second Concussion Among Pediatric Patients.” In collaboration with faculty mentor Shane M. Miller, M.D., David reviewed 31 pediatric cases in The North Texas Concussion Registry (ConTex).

A man is giving a presentation at a conference called rising to the challenge | CAMS RISING THE CHALLENGE A Longitudinal Evaluation of Differences in Presentation Between First and Second Concussions in Pediatric Patients UT Southwester SCOTTISH RITE ConTex SAMSS

Comparing variables between sport-related concussions within and between patients, the study aimed to identify the effects of a second concussion on young athletes. Findings included:

  • Pediatric patients presented similarly following first and second concussion and demonstrated similar time to return-to-play.
  • Neurocognitive abilities were not shown to be negatively impacted by a subsequent concussion.

Also representing data from the ConTex registry, Joshua A. Beitchman, M.D., M.B.S., UT Southwestern Medical School second-year resident in pediatric neurology, presented “Endophenotype presentation of athletes with concussion contingent upon sex and time since injury.” Working closely with his mentor and pediatric sports neurologist, Mathew Stokes, M.D., Dr. Beitchman, used a complex system called phenotyping to begin to explain the very difficult task of identifying treatment strategies earlier in the care of concussions. He says, “since concussed athletes experience symptoms differently based on sex and time since injury, predicting outcomes or the prognosis is challenging.” This study is making progress on these challenges in treating athletes with a concussion. A specific direction coming out of this effort is to further evaluate how mood and sleep affect recovery and learn interventions that will address these successfully in this population.

SM EDICINE Annual Meeting SAMESH Co-Authors RISING THE CHALLENGE. A man stands at a podium at an annual meeting

Pediatric Musculoskeletal Ultrasound Expert Shares Results of Novel Study
Sports medicine physician Jacob C. Jones, M.D., RMSK, presented “Increased Ultrasonographic Humeral Retrotorsion in Young Overhead Athletes with Little League Shoulder or Elbow.” This study adds to a small, but growing volume of evidence in the use of musculoskeletal ultrasound in the evaluation and research of pediatric sport-related conditions.

Comparing the shoulders of throwing athletes with and without shoulder or elbow pain with similar athletes in other overhead sports such as gymnastics, the study aimed to describe how the bone is remodeled, or changed, with a high volume of throwing. This study will aid in the understanding of growth-related, training-related and sport-related changes in the shoulder with sports that have a high volume of throwing such as baseball. In particular, studies like this will help to understand why some athletes develop pain with these activities and some do not.

Orthopedic Sports Medicine Fellowship – Vacancy

Orthopedic Sports Medicine Fellowship – Vacancy

The Scottish Rite for Children and UT Southwestern Medical Center (UTSW) Sports Medicine Fellowship is a new 12-month ACGME accredited fellowship program with an emphasis on pediatric sports medicine. Led by Philip L. Wilson, M.D., and Henry B. Ellis, M.D., this fellowship is an extraordinary clinical training program that allows physicians to master the skills needed to manage the full gamut of sport-related injuries in adults and pediatric patients including conditions such as osteochondritis dissecans (OCD), discoid meniscus, shoulder instability, femoroacetabular impingement (FAI) and a variety of anterior cruciate ligament (ACL) reconstruction options from a physeal-sparing to a traditional ACL with or without a lateral extra-articular tenodesis (LET). The fellowship will include exposure to fracture management that is common in athletes as well as osteotomies when indicated in athletes. 

The Sports Medicine program at Scottish Rite and UTSW participates in high level research as well as exposure to several multicenter study groups. The fellowship will also include experiences with quality improvement as this institution hosts a multicenter quality improvement initiative called SCORE – Sports Cohort Outcomes REgistry.

The one-year fellowship program is available to a postgraduate surgeon who has completed an orthopedic residency, but it may also be ideal for a surgeon who has just completed a fellowship who would like more exposure to pediatric sports medicine conditions and treatment. Currently, there is one position available for the 2023 cycle, and we are also accepting applications for the 2024 cycle. This fellowship is perfect for a PGY4 who is interested in sports medicine and may have been overlooked or gone unmatched. A PGY5 who is interested in a second fellowship is also an ideal candidate. 

Training Start: Clinical position to begin in August 2023 

Accredited Positions: 1 

How to Apply: Please send your contact information, CV and other supporting documents to orthosports.fellowship@tsrh.org. We would like to fill the position as soon as possible.

For more information about the Orthopedic Sports Medicine Fellowship, please visit the Fellowships & Graduate Programs page on our website.

SM-Fellowship-Web-Graphic-crop-2023-copy.jpg

Healio Orthopedics Today: MPFL Reconstruction

Healio Orthopedics Today: MPFL Reconstruction

Patellar instability most commonly affects skeletally immature pediatric patients with open growth plates and medial patellofemoral ligament reconstruction should be the primary treatment for first-time patellar instability in skeletally immature patients, despite historical use of the adductor sling technique.

Medical Director of Clinical Research Henry B. Ellis, M.D., recently discussed MPFL reconstruction for first-time patellar instability with Orthopedics Today. 

Watch the full segment