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Bryce’s Treatment is a Home Run

Bryce’s Treatment is a Home Run

by | Sep 30, 2024 | Sports Medicine

Header image courtesy of Eddie Kelly/ProLook.

When an injury threatened to keep Bryce off the baseball field for nine months, he and his family turned to Scottish Rite for Children to get him back in the game.

Bryce has always loved baseball. “I’ve been playing baseball pretty much ever since I could walk and get a ball in my hand,” he says. His mother, Johnette, first saw glimpses of Bryce’s outstanding athletic ability when he was 4. “When the other team was batting, it didn’t matter where Bryce was playing, he would go all over the field to get the ball,” she says. “He was kind of like a one-man-team.” Bryce started pitching when he was 8, and Johnette saw a drive and a passion that were unlike what she saw in other young athletes. When Bryce became a teenager, he played on select baseball teams, and he spent several summers traveling for games. Bryce’s drive and determination paid off his freshman year at McKinney High School when he made the varsity baseball team.

Like many star athletes, Bryce played several sports, and enjoyed football when he wasn’t playing baseball. Sport diversification can help prevent injuries caused by overuse, but unfortunately contact injuries are harder to prevent. In his junior year, he and his team had made it to the second round of the playoffs. During practice, to get ready for the big game, Bryce went for a block and, after contact, felt his arm go completely numb. “I thought it was just some bumps and a bruise because it’s football,” says Bryce. “So, I played that second round, and played every snap on offense and felt fine, but it turns out, it wasn’t too great.” The day after the game, he and a friend went to the baseball field to throw the ball around, but Bryce quickly realized that there was a problem. “I couldn’t even throw the ball five feet, because it was hurting so bad,” he says. 

Bryce had sustained a labral injury to his shoulder, which likely occurred when he subluxated (shoulder almost dislocated) or possibly dislocated (shoulder completely out of the socket) his shoulder. When the shoulder joint is injured this way, it can cause damage to the structures around the joint, including the labrum. The labrum is a ring of cartilage around the socket part of the ball and socket joint of the shoulder. When torn, the labrum is commonly thought to need surgery, but not always. 

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Initially, Bryce was told that surgery was necessary in order to return to sports and may take as long as nine months. This news devastated Bryce, so when his parents returned, they turned to the Scottish Rite for Children Orthopedic and Sports Medicine Center for another opinion. Pediatric orthopedic surgeon Henry B. Ellis, M.D., reviewed Bryce’s files and MRI, and felt that they could get him back to baseball with physical therapy instead of surgery. He felt with proper rehabilitation (physical therapy) and allowing enough time to allow the labrum to heal, Bryce could avoid a surgery and possibly be back to baseball sooner. However, this did mean that Bryce would have to give his shoulder enough time to heal before throwing a ball again.

Though encouraged by the option to avoid surgery, Bryce remembers being a little shocked at how difficult physical therapy was from the start. “It kind of killed my confidence a little bit and frustrated me, because I’ve always played a lot of sports and I always want to be the best that I can be. But once I saw improvement in how my body and my shoulder felt, I finally started getting back my confidence, so it was good.” Scottish Rite coordinated with the McKinney High School athletic trainers on a program to get Bryce back on the field as soon as possible.

Bryce was cleared to play in February, right before the team began preparing for the upcoming season. After all the hard work he had put into building back his shoulder, he was very excited to be with his team again. They were glad to have him back too – in Bryce’s first week back, he hit three home runs. Things were going great until COVID-19 forced an early end to the season. “All this is a little different,” says Bryce. “It’s like a curveball being thrown at us. But you just have to adapt and be able to adjust and focus on what you are there for.”

Bryce has complete confidence in his shoulder now. “I feel like I can do anything and everything that I’ve always been capable of doing,” he says. “If it wasn’t for Scottish Rite, I wouldn’t be where I am now.” Bryce recently verbally committed to play baseball at Northeast Community College in Mount Pleasant, Texas, and plans to continue his journey to Major League of Baseball.

Bryce is very grateful to Dr. Ellis. When others were recommending surgery, Ellis presented the pros and cons of a nonoperative plan. Bryce says he learned a lot from his experience. “When you go through hard times, you always have to keep your head straight and focus on the main goal, because you are going to go through ups and downs, but you just have to focus on the end result, and that was big for me. Not focusing on the negatives, but on getting back to where I needed to be.”

 

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Does my child need surgery to fix a clavicle fracture?

Does my child need surgery to fix a clavicle fracture?

by | Sep 28, 2022 | Sports Medicine

Pediatric orthopedic surgeons Henry B. Ellis, M.D., and Philip L. Wilson, M.D., along with colleagues from the multicenter study group Factors Associated with Clavicle Treatment Study (FACTS) have published another set of findings in the American Journal of Sports Medicine. This group, like many others in pediatric orthopedics and sports medicine, merges the experiences and data from across institutions to provide the best evidence for care in the pediatric population. This group focuses their efforts on collarbone (clavicle) fractures and injuries in children and adolescents.

Here are some highlights from the publication. You can also visit the journal’s website to read the full article.

  • Midshaft clavicle fractures most often occur in adolescents, yet, most medical evidence is in adults until now.
  • More than 400 patients (10 to 18 years) with 100% displaced clavicle fractures were included in the study.
  • After two years, there was no difference in outcomes between those that had surgery and those that did not.
  • Those who underwent surgery had more nerve damage (loss of sensation on their chest wall) and more second surgery to remove plates and screws.
  • The study conclusion states, “Surgery demonstrated no benefit in patient-reported quality of life, satisfaction, shoulder-specific function or prevention of complications after completely displaced clavicle shaft fractures in adolescents at two years after injury.”

So, the answer to the question, “Does my child need surgery to fix a clavicle fracture?” is not yes. But, that also does not mean it is no. The study describes the general experience of a large group patients who have and have not had surgery for this condition. The individualized assessment of the patient is still important and necessary, but the study does show that there is not an obvious answer that applies to all patients. “This work is new and very important for the growing body of evidence in caring for this population,” Ellis says. “We can confidently tell families that one path is not yet obviously better than another.” In our individualized patient care, it is important for us to provide evidence-based recommendations, and in our research, we aim to define the recommendations.

This study, Two-Year Functional Outcomes of Operative vs Nonoperative Treatment of Completely Displaced Midshaft Clavicle Fractures in Adolescents: Results from the Prospective Multicenter FACTS Study Group, was published in the American Journal of Sports Medicine in September 2022.

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.

Sports Specialization and Overuse Injuries in Young Athletes

Sports Specialization and Overuse Injuries in Young Athletes

by | Mar 9, 2020 | Sports Medicine

Article originally published in the Pediatric Society of Greater Dallas newsletter. Written by sports medicine physician Jane S. Chung, M.D.

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The good old days of unstructured child driven “free play” has been largely replaced by the current sports culture of structured sport specialization patterns, which involves year-round training and participation. Many kids often play for multiple teams of the same sport and there seems to be a trend of picking a single sport and training at a very high level and intensity at an earlier age.

The concept of specialization was first proposed by Ericsson and his colleagues in 1993, stating that to reach expert performance, one must practice 10,000 hours over 10 years in that specialized field, adding that one is also more likely to succeed if training is begun at an earlier rather than later age.

Although there is no validation that early sport specialization is a requirement for athletic success and despite the growing evidence that early sport specialization may negatively impact an athlete’s physical and mental health long term, the trend towards early specialization continues to grow as parents, coaches and athlete’s dream of reaching collegiate scholarships and playing at an elite level. The reality is that a very small percentage of aspiring young athletes reach this status, with only 3-11% of high school athletes going on to compete at the NCAA level and only 1% receiving an athletic scholarship, with as few as 0.03-0.5% of high school athletes making it to the professional level.

Sport specialization is defined as “intensive year-round training in a single sport at the exclusion of other sports.” Sports specialization can be divided into two groups:

  1. Early specialization (before puberty)
  2. Late specialization with early diversification (sampling)

The benefits of early diversification include allowing the child to experience different physical, cognitive and psychosocial environments and exposure to various types of sports. Emphasis should be placed on learning the fundamental movement skills such as running, throwing a ball, jumping and kicking at the younger ages which sets the foundation for later building on more complex skills as they progress in age and sport.

Current evidence suggests that for the majority of sports, delaying specialization until after puberty (15 or 16 years of age) with early diversification and participation in a variety of sports is more favorable for long term health and future athletic success. However, there are certain sports such as gymnastics, figure skating and diving in which early specialization may be required as peak performance in these sports occurs before an athlete’s full physical maturation.

Overuse
There is concern that early specialization and intense training at an early age may result in negative outcomes such as increased risk of injuries such as overuse injuries and increased psychological stress, potentially leading to drop out from sports and burnout. However, there are other risk factors that have been identified for causing overuse injuries (See Table 1).

Table 1
A table showing the categorization of risk factors for overuse injury | Categorization of Risk Factors for Overuse Injury Intrinsic Risk Factors Growth-related factors • Susceptibility of growth cartilage to repetitive stress • Adolescent growth spurt Previous injury Previous level of conditioning Anatomic factors Menstrual dysfunction Psychological and developmental factors • Athlete specific Extrinsic Risk Factors Training workload • Rate • Intensity • Progression Training and competition schedules Equipment/footwear Environment Sport technique Psychological factors • Adult and peer influences DiFiori JP, Benjamin HJ, Brenner JS, et al. Overuse injuries and burnout in youth sports: a position state- ment from the American Medical Society for Sports Medicine. Br J Sports Med. 2014;48: 287-288.
Skeletally immature athletes are also susceptible to unique overuse injuries involving the growth plates and apophyses. The risk of injury in a young athlete also varies upon factors including training volume, intensity, level of competition and pubertal maturity. Studies have shown that sport specialization is an independent risk factor for injury and that those athletes who participated in more organized sports compared to free play in a ratio greater than 2:1, had an increased risk for an overuse injury.  In general, the risks of injury from intense training and specialization seem to be multifactorial and variable, dependent on age, growth rate, pubertal maturation and level of competition.

Burnout
It is important as pediatricians to keep burnout in mind when treating young athletes. Burnout can result from excessive chronic stress which the athlete may be experiencing, and can manifest as decreased appetite, poor sleep, decreased performance, low self-esteem and ultimate withdrawal from sport. Sports or activities that they used to enjoy are no longer fun or pleasurable. For those health care providers taking care of young athletes, it is important to recognize burnout as a sequela of overtraining and to be aware of its manifestations and presentations. The diagnosis of burnout and overtraining is made through the athlete’s history and recognition of various nonspecific symptomatology which the athlete may present with. Further imaging and laboratory studies should be performed only if clinically indicated. Physical and mental rest are key components for treatment. A multidisciplinary approach should be taken for treatment, involving the athlete, parents, coaches, treating physician and sometimes a mental health specialist.

Our goal as pediatricians is to help kids stay healthy, happy and active for life. To prevent burnout/overtraining and overuse injuries in young athletes, here are some tips (See Figure 1).

Figure 1
Guidance for sports specialization and intensive training in young athletes | Guidance for Sports Specialization and Intensive Training in Young Athletes RECOVERY Taking 1 month off from a sport at least 3 times per year allows for physical and psychological recovery. INJURY PREVENTION 00000 Having at least 1 to 2 days off per week from a sport can decrease the chance for injuries. PRIMARY FOCUS Learn and develop lifelong physical activity skills and enjoyment. MAINTAIN A VARIETY Participating in multiple sports decreases the chance of injuries, stress and burnout. SPECIALIZATION Delaying specializing in a single sport until late adolescence may lead to a higher chance of accomplishing athletic goals. EARLY DIVERSIFICATION AND SPECIALIZATION Provides a greater chance of lifetime sports and physical activity involvement, and possibly elite participation. Adapted from Brenner J. S. Sports Specialization and Intensive Training in Young Athletes. Pediatrics 2016, volume 138, number 3
Learn more about pediatric sports medicine.

Little Leaguer’s Shoulder Syndrome

Little Leaguer’s Shoulder Syndrome

by | Oct 7, 2019 | Sports Medicine

We continue to see preventable injuries in young throwing athletes. We are hopeful that continued efforts to educate parents, athletes and coaches will encourage them to comply with recommendations for pitch counts and days of rest to protect throwing arms. Children and adolescents should not experience activity-related pain and should not be encouraged to play through pain.

Many are familiar with Little Leaguer’s elbow syndrome. However, there seems to be a continued lack of awareness regarding a similar injury in the shoulder. Little Leaguer’s shoulder syndrome, also called proximal humeral epiphysiolysis, is the most common diagnosis associated with young throwing athletes with complaints of shoulder pain. Though its name correctly associates it with the higher occurrence in young baseball players, it can be also be a problem for athletes in other sports including softball, volleyball, tennis, gymnastics and swimming. These sports require similar repetitive overhead motions used by a baseball pitcher.

This shoulder condition is only seen in athletes with open growth plates. These are the growing areas of the bone that are relatively soft because the cartilage has not yet matured into hard ossified or calcified bone. These areas disappear when the bone has completed growth. The growth plate is softer than the bone on either side of it and therefore is at a greater risk of injury. The repetitive motions in sports can cause cumulative small injuries to these areas. Without proper rest and recovery, this can lead to pain and widening of the growth plate.

Little Leaguer’s shoulder syndrome is a condition of the growth plate of the upper end of the upper arm bone, the humerus. Because the rotator cuff muscles in the shoulder attach to the bone above the growth plate and other muscles attach below the growth plate, there is a rotational or twisting stress across the growth plate with each throw.

Little Leaguer’s shoulder may be seen in athletes as young as 8 or 9 years of age. It is rarely seen beyond age 15 or 16. When the growth plate is ossified, repetitive activity may then lead to other types of injury. A diagnosis is typically made with a physical exam and standard shoulder X-rays. In some cases, an X-ray of the opposite shoulder is used to compare the growth plates to confirm the diagnosis. An MRI of the shoulder is not necessary and, in most cases, should be avoided to minimize costs.

With early recognition, Little Leauger’s shoulder syndrome is successfully managed with rest from throwing for a period six to 12 weeks. Exercises that include shoulder stretches and strengthening can be added when symptoms improve. A proper program focuses on flexibility and stability around the shoulder and throughout the body. An interval throwing program is a strategic approach to returning to throwing starting with short tosses and progressing to longer and faster pitches. After completion of this program and when symptoms have completely resolved, the athlete can return to overhead throwing sports.

Overuse injuries are considered preventable. Here are tips to keep a throwing arm injury free:

  • Focus on proper form with each throw.
  • Stop throwing when tired.
  • Follow pitch count guidelines.
  • Respond early to complaints of pain during or after throwing.
  • Schedule rest throughout the week and throughout the year.

Additional education:
Key concepts for injury prevention in baseball players

Learn more about pediatric sports medicine.

This information has been edited from an original article by Chuck Wyatt, R.N., CPNP, RNFA, submitted for publication on another website.