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STAY IN THE GAME
Tips and information for coaches, athletes and parents, brought to you by the orthopaedics
and sports medicine experts at Mercy Health | FALL 2016
We’re Mercy Health —
caring for more than 70
high schools, clubs, colleges
and professional athletes
including Miami University
and the Cincinnati Bengals.
IN THIS ISSUE
• Seasonal tips:
-T
reatment of traumatic
shoulder injuries
- Upper extremity program
helps athletes safely return
to play
- Understanding concussions
- A focus on the knee
•M
ercy Health Orthopaedics
and Sports Medicine cares
for student athletes and
supports their coaches
• First aid kit check list
Treatment of traumatic shoulder injuries
BY MARC GALLOWAY, MD
Shoulder injuries commonly occur in sports that involve contact or
require overhead use of the arm. Over the last several years,
arthroscopic shoulder surgery has replaced ACL reconstruction as
the procedure that is most frequently reported by participants at the
NFL Combine. Among the most common shoulder injuries are
subluxations and dislocations.
The shoulder is a ball and socket joint in which the ball (humeral
head) glides in a socket (the glenoid) much as a golf ball sits on a tee.
Marc Galloway, MD
Because the ball is so much larger than the socket, the stability of the
shoulder is provided entirely by a combination of ligaments (rope-like structures that
connect the bones to one another), the labrum (a washer-like structure that helps to
deepen the socket side of the joint and provide an anchor point for the ligaments) and, to
a lesser extent, the muscles surrounding the shoulder joint. Subluxations occur when the
humeral head partially slips out of the glenoid then spontaneously returns to its normal
position. A dislocation connotes a complete separation of the ball from the socket and
requires that a healthcare provider perform a maneuver that returns the bones to their
normal resting position.
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Either of these injuries can result in partial or complete
tearing of the ligaments, the labrum or both. In extreme
cases, a fracture can also occur. X-rays are usually useful
as a screening tool for fractures. However, an MRI is the
most accurate diagnostic test for determining the extent
of structural injury in these patients and can guide the
decisions regarding the most appropriate treatment.
ANTERIOR SHOULDER INSTABILITY
Instability of the shoulder is classified by the direction in
which the humeral head shifts during the injury. In anterior
instability, the head is forced out the front of the socket.
Tears of the anterior labrum and the associated ligaments
will frequently occur. These injuries usually happen when
the arm being levered away from the body, either out to
the side or over the head. In football, these most
commonly happen when a player is making a tackle
or falls on an outstretched arm.
These injuries can also occur in patients who do not
play sports as a result of accidents or falls. Anterior
shoulder subluxations and dislocations are the most
common pattern of instability that are seen in athletes
and can carry a high risk of recurrent injury in certain
groups. Older or less athletic individuals can be
successfully managed with a brief period of rest
followed by rehabilitation.
Surgical repair of the damaged structures is more
appropriate for younger individuals and especially
for those participating in organized sports. Depending
on the severity of the injury and the number of dislocation
episodes, surgery can be performed utilizing either
arthroscopic or open techniques. Arthroscopic techniques
offer the benefit of less pain and easier rehabilitation and
can provide a successful outcome for the majority of
patients. Open surgical techniques are indicated for
patients who have sustained significant bony injuries.
TREATMENT CONSIDERATIONS
While surgery represents the most definitive management
for athletes involved in contact sports, the timing of the
procedure can vary depending on the severity of injury,
the degree of instability, and at what point during the
season the dislocation occurred. For those desiring to
complete their sports season, the treatment is to support
the injured limb in a sling until comfortable then institute
a rehabilitation program designed to restore range
of motion and strength to normal levels.
Athletes can typically be expected to return to their sport
at about three weeks following injury. Braces are available
that can help prevent recurrent injury upon return, but
they are not foolproof and can restrict shoulder motion
and impair athletic performance. The risk of recurrent
injury is generally felt to be acceptable after an initial
dislocation; however, since multiple repeat dislocations
can jeopardize the outcome after surgery, I usually do
not recommend that athletes who sustain a second
dislocation return to play until after the shoulder is
stabilized. Surgery is successful in returning patients
to their desired activity level in more than 90% of cases.
POSTERIOR INSTABILITY
Posterior instability occurs when the humeral head is
forced out of the back of the shoulder and usually results
in a posterior labral tear. This pattern of injury is most
often seen during blocking type activities in which the
hands are in front of the body and the patient is pushing
against another player. I most commonly see these injuries
in linebackers and offensive linemen. A patient’s outcome
depends on the severity of ligament and labral injury.
Initial treatment for these injuries is rehabilitation with
the goal of restoring muscle strength.
TREATMENT CONSIDERATIONS
Bracing is largely ineffective for posterior instability of the
shoulder. For patients who remain symptomatic following
non-surgical treatment, arthroscopy with posterior labral
repair is an effective treatment. Patients can expect to
return to full athletics at six months following their
surgical procedure.
Dr. Marc Galloway is a Sports Medicine Surgeon who specializes in knees and
shoulders. Dr. Galloway is the Head Team Physician for the Cincinnati Bengals
and has office hours in Mason, OH and Crestview Hills, KY. To schedule an
appointment with Dr. Galloway, call 513-347-9999.
FA L L | 2
Upper extremity program helps athletes safely return to play
BY CHAD SMITH, PT
Student athletes of the past were likely to participate
in a variety of sports over the course of a year. Today,
it’s not unusual for athletes to specialize in one sport,
focusing on it year round. Not surprisingly, over the past
two decades, we’ve seen significant increases in upper
extremity injuries among athletes who dedicate
themselves to “overhead” sports.
In some overhead sports, such as football, the most
common cause of injury to the upper extremity is direct
trauma to the involved area, while in others, such as
volleyball, baseball and softball, the most common causes
are inadequate pre-season preparation and overuse.
When upper extremity injuries are left untreated or not
treated properly, athletes may spend days, weeks or
months away from their sports.
To help student athletes stay in the game, Mercy Health
Orthopaedics and Sports Medicine has established an
evidence-based and comprehensive return-to-play
program designed specifically for “overhead” athletes.
The program is designed for athletes recovering from
upper extremity injuries who have completed
rehabilitation with their therapists or athletic trainers but
have not reached a point where they can safely return to
their sports and compete at the highest level possible.
Mercy Health’s upper extremity program consists of four
phases that address the entire spectrum of issues that the
recovering athlete must face, including strength deficits,
muscle imbalances, sport-specific functional deficits and
the athlete’s fear of returning to the activity associated
with their injury. While the first two phases of the program
focus primarily on isolated and dynamic strengthening of
the lower extremity, core and upper extremity, the final
two stages focus on performing activities specific to their
sport and a graded return to competitive play.
The program utilizes a series of computer-based strength
testing, dynamic activity testing and athlete-reported
questionnaires to help determine when identified goals
are met. Progression from one stage to the next is
criterion-based: athletes transition when their goals for
the current stage are achieved. Mercy Health’s upper
extremity program is designed to assure a safe and
confident return to sport for athletes that allows them to
play at their highest ability, while providing a stable
foundation for preventing future injuries. To learn more,
please email [email protected]
Chad Smith is a physical therapist with Mercy Health. He specializes in treating a
variety of sports medicine and orthopaedic problems with a focus on knees and
shoulders.
Mercy Health Orthopaedics and Sports Medicine cares for
student athletes and supports their coaches
Mercy Health Orthopaedics and Sports Medicine staff
have been busy throughout the summer preparing
athletes and coaches for the 2016-2017 school year.
A variety of activities were conducted, including Sports
Physicals, Pupil Activity Coaches Courses, Sports
Combines and Sportsmetrics Training. The Mercy team
of Sports Medicine physicians, primary care physicians,
physical therapists and athletic trainers provided more
than 2,100 pre-participation physicals, conducted
presentations to more than 100 coaches on basic first aid
and the importance of recognizing concussions, tested
more than 600 athletes during Sports Combines to collect
valuable data, and trained more than 100 athletes in
Sportsmetrics, an ACL injury prevention program.
Mercy Health Orthopaedics and Sports Medicine is
committed to providing exemplary care to athletes
of all ages. With more orthopaedic physicians, physical
therapists, athletic trainers and convenient locations
throughout Greater Cincinnati than any other provider,
you can be assured of being seen by experts in a
timely manner.
Understanding concussions
BY EDWARD MARCHESCHI, MD
With student athletes now training
and competing, coaches and parents
are focused on helping them stay
safe. A key concern, especially related
to contact sports, are concussions.
The brain floats inside the skull. When
the head takes a hard hit or is
violently jostled, the brain bounces
Edward
back and forth off the skull. This may
Marcheschi, MD
mechanically stretch nerve fibers
abnormally, triggering a chemical reaction in the brain at a
cellular level. This injury is what we call a concussion. An
athlete’s vulnerability to a concussion is dynamic and there
are many factors other than traumatic force that contribute
to this vulnerability.
The most common symptoms of concussion may include
headache, dizziness and memory impairment. The
symptoms of concussion can worsen over 24 to 48 hours.
The good news is that the ill effects of concussion will
resolve in most athletes if the injury is managed
appropriately. Rest, both physical and mental, is
recommended treatment for concussion early on. A
student athlete diagnosed with a concussion should avoid
physical exertion and decrease mental concentration by
limiting sensory input by refraining from using computers,
texting, watching TV and playing video games.
Baseline testing is recommended for all athletes in contact
and collision sports. Using a computer-based
neuropsychological test called ImPACT, athletes age 10 and
older can be proactively tested. ImPACT creates a baseline
of what’s normal for the individual, documenting several
aspects of the athlete’s brain function. If the student sustains
a head injury, the test is then re-administered. By comparing
new results against the baseline, physicians are able to
determine the severity of the concussion, predict recovery
time and monitor recovery. Mercy Health provides ImPACT
testing for concussions at all of our partner schools.
When concussions are managed appropriately, student
athletes can make full recoveries and eventually resume
their sports.
Dr. Edward Marcheschi is a Primary Care Sports Medicine Specialist trained in
musculoskeletal ultrasound. He treats patients at offices in Mason, West Chester
and Oxford. To schedule an appointment, call 513-981-6784.
First aid kit check list
Most high schools are fortunate to have a certified athletic trainer on-site should an injury occur, but with so many events
taking place, the athletic trainer may not always be there. Coaches should have a first aid kit, especially when traveling to
away games. Below is a sample of items to include in the kit:
Athletic Tape — 2-3 rolls of 1½” athletic tape:
Purpose: To be used for not only injury protection, but
also assist with uniforms/equipment.
re-Wrap — 1-2 rolls
P
Purpose: To protect the skin when using athletic tape.
Some athletes use it to pull back their hair.
Antibiotic ointment
Purpose: To prevent infection of a wound or cut.
mall mirror or compact case
S
Purpose: For an athlete to see their reflection (i.e., putting
in contacts)
atex and/or latex-free gloves
L
Purpose: Protection from blood/body fluids is critical.
PR mask/microshield
C
Purpose: To be used for personal protection/limiting
transmission of infection.
terile gauze
S
Purpose: To be used for cleaning or controlling blood/
body fluids while limiting the risk of infection.
cissors/nail clippers, preferably medical scissors
S
Purpose: To be used for tape removal or other cuttings
(i.e., bandages or other packages).
ssortment of Bandages
A
Purpose: To be used for stoppage of blood from minor
cuts/scrapes and act as a barrier from infection.
Ice bags
Purpose: For the obvious reason to ice an injury.
ose plugs or small tampons
N
Purpose: To be used for bleeding control of the nose.
ubbing alcohol or hydrogen peroxide
R
Purpose: To be used for cleaning an injury site as well as
uniforms, etc.
otepad and pen
N
Purpose: To be used to write down description of the
event, names, etc.
hone list for parents, hospitals, athletic trainer,
P
athletic director
Purpose: In the event of injury, notify these people
if necessary.
FA L L | 4
A focus on the knee
BY SURESH NAYAK, MD
Athletes in a variety of sports are
prone to common overuse injuries of
the knee. Many of these occur in the
anterior or front part of the knee
around and including the knee cap
(patella). Before looking at common
injuries, let’s look at the complex
physiology of the knee.
Suresh Nayak, MD
STRUCTURE OF THE KNEE
The four quadriceps muscles meet just above the patella
to form the quadriceps tendon, which attaches the
quadriceps muscle to the patella. The patella is attached
to the shinbone tibia by the patellar tendon. Working
together, the quadriceps muscle, quadriceps tendon
and patellar tendon straighten the knee. With repetitive
pulling on the patella or explosive jumping, overuse
injuries are common.
COMMON KNEE INJURIES
• Quadriceps tendinitis occurs when there is an
inflammation of the tendon where it attaches to the top of
the patella. It is very common in athletes who participate
in running and jumping sports. When the tendon is
weakened, tearing or rupture of the tendon may occur.
•P
atellar tendinitis is a common overuse injury to the
tendon connecting the patella to the tibia. Patellar
tendonitis, also known as “jumper’s knee,” is common in
athletes whose sports involve frequent jumping, such as
basketball and volleyball.
• Osgood Schlatter disease is also known as apophysitis of
the tibial tubercle. It is an inflammation of the patellar
tendon as it attaches to the growth plate around tibial
tubercle. It is characterized by a painful bump just below
the knee and most often is seen in young adolescents. Risk
factors include overuse and adolescent growth spurts.
The above conditions often respond to conservative
management, which includes a period of rest, oral
inflammatory medications, icing and stretching exercises.
Organized physical therapy is frequently used to stretch
and strengthen weakened muscles. Braces can be helpful
in the short term as well. Surgery is used as a last resort
for those rare cases that do not improve with conservative
care, for tendon tears or for athletes with anatomical
problems predisposing them to injury.
Play can be resumed when the athlete is pain free. To
reduce the likelihood of knee injuries, it is important that
athletes focus on proper conditioning, especially in the
off-season.
Dr. Suresh Nayak is an orthopaedic surgeon who specializes in a variety of sports
medicine and orthopaedic injuries, including knees, shoulders, hips and joint
replacement. Dr. Nayak treats patients at Wellington Orthopaedic and Sports
Medicine in Anderson. To schedule an appointment call 513-232-2663.
• Chondromalacia patella or patellofemoral pain syndrome
is a broad term used to describe pain in the front of the
knee and between the kneecap and thighbone
(patellofemoral joint). Chondromalacia patella refers to
inflammation or softening of the cartilage behind the
kneecap. The pain and stiffness it causes can make it
difficult to climb stairs, kneel down and perform other
every day activities. Many things may contribute to the
development of patellofemoral pain syndrome. Problems
with the alignment of the kneecap and overuse from
vigorous athletics or training are often significant factors.
SUMMER | 5
After hours, extended hours and Saturday morning Sports Injury Clinics
We’re here to help after hours. No appointment necessary unless noted.
Anderson
7575 Five Mile Rd. Cincinnati, OH 45230
513-624-4100 | Hours: M–F 5–9 p.m. | Sat. 9 a.m.–1 p.m.
Crestview Hills (KY)
328 Thomas More Pkwy. Crestview Hills, KY 41017
513-347-9999 | Hours: T/W 5–7:30 p.m. (Appointment
required) | Sat. Sports Injury Clinic (Aug.–Dec.)
Fairfield (HealthPlex)
3050 Mack Rd., Suite #200 Fairfield, OH 45014
513-924-8220 | Hours: M–F 5–9 p.m. | Sat. 9 a.m.–1 p.m.
Mason/Deerfield
5236 Socialville Foster Rd. Mason, OH 45040
513-347-9999 | M–F extended hours available,
(Appointment required) | Sat. Sports Injury Clinic
(Aug.–Dec.)
Western Hills
6350 Glenway Ave., Suite 415 Cincinnati, OH 45211
513-347-9999 | Sat. Sports Injury Clinic 8–10 a.m.
Outstanding orthopaedic and sports medicine care, conveniently located
ORTHOPAEDICS AND SPINE
513-981-ORTHO (981-6784)
Anderson
7575 Five Mile Rd.
Cincinnati, OH 45230
Eastgate
4440 Glen Este-Withamsville Rd.
Cincinnati, OH 45245
Fairfield
3050 Mack Rd., Suite 200
Fairfield, OH 45014
Harrison
10450 New Haven Rd.
Harrison, OH 45030
Kenwood
4750 E. Galbraith Rd., Suite 105
Cincinnati, OH 45236
West
3301 Mercy Health Blvd.
Suite 450
Cincinnati, OH 45211
ORTHOPAEDICS AND
SPORTS MEDICINE
Cincinnati SportsMedicine &
Orthopaedic Center
Crestview Hills
328 Thomas More Pkwy.
Crestview Hills, KY 41017
513-347-9999
Mason
5236 Socialville Foster Rd.
Mason, OH 45040
513-347-9999
Blue Ash
4701 Creek Rd., Suite 110
Cincinnati, OH 45242
513-733-8894
Montgomery
10663 Montgomery Rd.
Cincinnati, OH 45242
513-347-9999
Eastgate
4440 Glen-Este Withamsville Rd.
Cincinnati, OH 45245
513-753-7488
Rookwood
4101 Edwards Rd.
Second Floor
Cincinnati, OH 45209
513-347-9999
Oxford
270 S. Locust St.
Oxford, OH 45056
513-524-1018
Tri-County
12115 Sheraton Ln.
Cincinnati, OH 45246
513-347-9999
Western Hills
6350 Glenway Ave. Suite 415
Cincinnati, OH 45211
513-347-9999
WELLINGTON ORTHOPAEDIC
AND SPORTS MEDICINE
A partner of Mercy Health
Adams County
230 Medical Center Dr.
Seaman, OH 45679
937-386-3420
Anderson
7575 Five Mile Rd.
Cincinnati, OH 45230
513-232-6677
We’d like to hear your thoughts on this issue of Stay in the Game
and topics you’d like covered in future issues. Please send your
suggestions and thoughts to [email protected].
7542CINNWL (9/16)
Sardinia
7109 Bachman Rd.
Sardinia, OH 45171
513-753-7488
West Chester
8737 Union Centre Blvd.
West Chester, OH 45069
513-645-2220
West
3301 Mercy Health Blvd., Suite 450
Cincinnati, OH 45211
513-232-6677
Health information on the web
At MercyMovesYou.com, you’ll find
information and videos that help
athletes protect their health and
avoid injury.