Posts Tagged ‘sports medicine south’

SMS “Wrestles” Skin Diseases

Wednesday, February 17th, 2010

              As we begin a new year, the end of the GHSA wrestling season also approaches.  This week, wrestlers from all over the state of Georgia will “meet” up at the Gwinnett Arena to determine who the best of the best is.   Along with the occasional bloody nose and lacerated eyebrow, wrestlers also have to be conscious of their skin.  There are many common skin disorders that surround contact sports, and with the upcoming GHSA State Wrestling Championship, I thought it might be helpful to list a few of them here. As a partner in Sports Medicine for the GHSA, Dr. Levengood and his staff will be providing on-site medical coverage for the tournament and will also take part in the mandatory skin checks that all wrestlers must submit to and pass before being eligible to compete.  While it is the responsibility of the athletes’ parents and coaches to be aware and educated on skin disorders and communicable diseases, it ultimately falls onto the shoulders of the evaluating physician of the event (i.e. Dr. Levengood). 

Here are some common skin disorders and the signs* and symptoms* to be aware of or look for if you or someone you love competes in any contact sport:

Herpes Gladiatorum: skin disease caused by the herpes simplex virus type 1; spread by skin to skin contact; most commonly found on the head/neck

                Signs: clusters of small blisters (sometimes fluid-filled) like those seen with chickenpox

                Symptoms:  fever, sore throat, headache

In order to be cleared for competition, the physician covering the event must determine that the athlete is fever free, cannot have had any new blisters within 3 days of clearance, any old blisters must be crusted over, and the athlete must be on medication for at least 5 days before the event.

 Staph Infection (Impetigo, Folliculitis, MRSA)

                Impetigo:  bacterial skin infection caused by strep/staphylo-coccus; spread by close contact or sharing towels, sheets, etc; can also spread by scratching; most commonly found around the nose and mouth

Signs/Symptoms:  sores begin as small red spots and change to blisters that eventually open; sores often ooze fluid or look crusted over (may be painful/itchy)

               

                Folliculitis:  bacterial skin infection caused by strep/staphylo-coccus; inflammation of one/more of the hair follicles; occurs with close personal contact; typically occur on neck, axilla, or groin area

                Signs/Symptoms:  rash; pimples or pustules around hair follicle; may crust over; itchy skin

               

                MRSA (methicillin-resistant staphylococcus aureus): bacteria that causes infections in other parts of the body; tougher to treat because it’s resistant to most commonly used antibiotics; can be transmitted by skin-skin contact

Signs:  red, swollen painful abscess; may be puss-filled; often mistaken for an insect bite or pimple; fever

                Symptoms:   cough, shortness of breath, chills

For all of the above Staph infections, in order for an athlete to be cleared for competition, the physician covering the event must determine that the athlete has been on a course of antibiotics for at least 3 days and has had no new sores for at least 2 days prior to competition.  All lesions must be covered with bandages that will not fall off during competition from sweat or contact.            

                These are just some of the common skin infections that are associated with contact sports.  It is important for parents/coaches to become familiar with many different types of skin disorders to properly identify lesions and know when medical intervention is necessary.  Prevention is the best way to protect yourself from any infection, viral or bacterial. Always wash your hands with soap and water after any contact with possible contaminated surfaces (i.e. other people, using the bathroom, etc).  In terms of athletics, always be sure to wash your athletic equipment, make sure proper cleaning techniques are used on community equipment (benches, machines, mats, tables) and identify any skin lesions/abnormalities as soon as you can so that treatment can take place as soon as possible. 

Dr. Levengood and the staff at Sports Medicine South would like to wish all the wrestlers competing this weekend good luck and safety as they battle for the State Championship!!

 

*Sign: what is objectively discovered during a physical examination (elevated blood pressure)

*Symptom: experienced and reported by the patient (nausea, headache)

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GHSA State Championships

Thursday, December 17th, 2009

As 2009 comes to a close, so does the 2009 football season. Over the weekend, Georgia’s finest football teams made a trip to the illustrious Georgia Dome to battle it out on the turf for the championship title—and the bragging rights.

As the sports medicine provider for the GHSA, Dr. Levengood and his team were on the sidelines to ensure the health and safety of all the young athletes. As we looked on, we were privileged to watch all 5 divisions display hard work and class while representing their schools. During the course of the weekend, we witnessed a barn-burner, a broken record, and a blowout.

Congratulations to all the players and coaches for making it to state and congratulations to all of the 2009 State Champions from Dr. Levengood and all of his staff at Sports Medicine South!

A – WILCOX CO vs. SAV CHRISTIAN 30-21

AA – BUFORD HS vs. CALHOUN 13-10

AAA – PEACH CO vs. GAINESVILLE HS 13-12

AAAA – SANDY CREEK vs. CLARKE CENTRAL 29-15

AAAAA – CAMDEN CO vs. N. WARNER ROBBINS 31-3

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Shoulder Injuries, Part II

Friday, July 3rd, 2009

There are three factors which predispose you to rotator cuff tendonitis:  a weakness or imbalance of the muscles around the shoulder; a lack of endurance in the muscles of the rotator cuff to perform the given task; lack of flexibility which decreases the rotator cuff’s ability to sustain forces exerted upon it.

The first cause is typically seen in football players or body builders who bulk up the large muscles around the shoulder (deltoid, biceps and pectoralis) but neglect the rotator cuff muscles. The pull of these large muscles overcome the ability of the rotator cuff to keep the humeral head located in the glenoid and it subluxes or slides out of the glenoid causing added stretch and injury to the tendons.  When this is repeated numerous times it causes micro-tears in the tendon. If ignored, this can lead to a damaged rotator cuff.

The second cause is usually seen in the golfers or tennis players who go out and play more than they are accustomed, an extra nine holes or that extra set.  Pitchers and quarterbacks are prone to this when they are at the end of a game and have thrown more than usual.  Typically, as you continue past the point of endurance the arm becomes heavy and numb.  Pitchers refer to this as “throwing their arm out”.

The third cause is prevalent in throwing athletes in their dominant arm. So much force is generated when throwing a ball to the plate or throwing to the end zone that the fibers of the tendon separate.  As the tendon heals, it contracts and tightens.  As this is repeated over the course of a season, the player actually loses range of motion in their shoulder.

In Part III, we will discuss ways in which the likelihood of shoulder injuries can be reduced.

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Shoulder Injuries, Part I

Tuesday, June 30th, 2009

Shoulder injuries are far too prevalent in many sports.  These injuries tend to fall into two groups.  The least common are those injuries caused by a sudden traumatic force, as seen with the football player being tackled and landing oddly, causing a dislocation or separation of the shoulder.

The more common injury type is the overuse injury that occurs in athletes who are involved in weightlifting, throwing, swimming, swinging clubs or racquets.  The majority of these injuries are preventable with a program of specific shoulder exercises and an understanding of the workings of the shoulder joint.

The shoulder is the most mobile joint in the body.  The shoulder joint looks like a golf ball sitting on a tee.  The humeral head (ball) sits in the glenoid (socket) which is shaped like a shallow dish.  A circular structure of soft tissue, the labrum, deepens the dish.  The stability of the shoulder joint is provided by the labrum and the tendons of the rotator cuff.  The rotator cuff is comprised of four small but very powerful muscles.  They wrap around the humeral head to keep it located in the glenoid.  The rotator cuff also internally and externally rotates the upper arm (humerus).  Above the rotator cuff tendons is a water-filled sac or bursa that reduces friction and cushions the rotator cuff tendons as they slide under the cowl of bone on top of the shoulder, the acromion.

The shoulder works in a balancing act, a force couple, between the deltoid and the rotator cuff. As you raise your arm the deltoid contracts to bring your arm up.  The rotator cuff muscles contract in synchrony to depress the humeral head ointo the glenoid. If your rotator cuff muscles are weak or your deltoid overpowers them, then the shoulder subluxes (partially dislocates) and rides up against the acromion.  This in turn pinches the tendons and bursa between the two.  This is called impingement.  Repeated often enough and the tendons and bursa become irritated and swell.  This leads to tendonitis, bursitis or even a small tear in the rotator cuff tendons.

Part II will discuss factors which predispose you to rotator cuff pathology, ways to reduce the likelihood of injury, and treatment options.

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Knee Pain, Part II.

Thursday, June 11th, 2009

Depending on the extent of the tear and location, some meniscal injuries can be treated without surgery.  Physical therapy to increase muscle strength around the joint and increase your range of motion along with anti-inflammatory medication, knee sleeves, activity modification and time are the regimen.  However, you should have significant improvement within 2-3 months if this approach is working for you.  If little or no improvement is felt, then surgery to remove the part of the meniscus is indicated.  In younger athletes, surgery is generally the better option if the meniscus can be repaired.  Repairing the meniscus can prevent further deterioration of the joint and help to prevent arthritis later in life.

Surgery for meniscus tears is an outpatient procedure which can generally be done in under an hour.  It is performed through two small poke holes in the knee.  One hole is for the arthroscope, a lighted tube connected to a television screen, which is used to visualize inside the joint.  The other hole is for the instruments which are used to either repair or trim the torn meniscus.  If the meniscus is repairable, an additional small incision on the side of the knee may be used to retrieve the sutures and protect the nerves that travel in the skin around the knee.  You are generally allowed to go home within 2-3 hours following the surgery.

Recovery from meniscal surgery varies for different people depending on the extent of other damage to the knee structures and the person’s age.  Some athletes have arthroscopic surgery and are back playing in 2-3 days; however, most people take 2-3 weeks to regain their strength and get rid of their swelling.  If the meniscus was repaired, then you will usually have to be on crutches for 4-6 weeks to allow the meniscus to heal properly.  This is a great improvement over what was the norm 15 years ago when open surgery was done through a large incision and you were out of competition for 3-6 months.

The meniscus is an important structure in the knee joint and as much of it as possible should be preserved.  The meniscus cushions the knee joint and prevents the ravages of arthritis.  Through modern surgical techniques and improved rehabilitation, a quicker return to sports or work is possible for this bothersome condition.

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Knee Pain, Part I.

Thursday, June 4th, 2009

Many of you have friends or have heard it said that they have “torn cartilage” in their knees.  They are probably not talking about the cartilage that covers the end of the bone – the articular cartilage – but rather  a tear of one of the two bushings in the knee, a meniscal tear.  These are rather common injuries in athletes and in the general population and tend to increase in frequency with increasing age of the individual.

Each knee has two of these fibrocartilaginous bushings, the medial meniscus (inside) and the lateral meniscus (outside).  These menisci act as shock absorbers in the knee and help to conform the shape of the two bones of the knee, femur (thigh bone) and tibia (shin bone) to one another.  The menisci also act in concert with the ligaments and muscles to provide stability to the knee.  The medial meniscus is attached securely to the ligaments on the back and on the inner side of the knee and because of this attachment is the more frequently torn of the two.

The menisci can be torn when there is a sudden, unexpected twisting motion to the knee.  This motion traps the meniscus between the ends of the two bones and causes a shearing action on the tissue.  This frequently happens in conjunction with ligament injuries, especially ACL tears.  As you get older your menisci becomes softer and the blood supple decreases.  This can lead to tears with little or no trauma; sometimes just a misstep will cause a tear.

When your meniscus tears you will usually feel a sharp pain on that side of the knee at the joint line.  Generally, the knee will then start to swell within a few hours.  You may find your knee locks up on you and you are unable to straighten it all the way.  This occurs because the meniscus flips into the joint and forms a mechanical block to motion.  The swelling will eventually decrease and the pain will subside with time and you may feel your knee is back to “normal”.  It might not even bother you too much when walking straight ahead; however, when trying a sharp cut or turn you may experience a return of the sharp pain.

To determine whether you have a meniscal tear, your doctor will ask you questions about how the injury occurred and then will examine your knee.  This usually involves moving the knee around if it is not too inflamed and pressing over your joint line on either side.  Sometimes as your knee is moved from bent to straight a pop can be felt as the torn meniscus moves out of the way.  X-rays are usually taken just to assure there are no broken bones or loose bodies floating around the knee.  The X-ray will not show the torn meniscus as X-rays only show bone detail and not soft tissue.  Sometimes, if there is question remaining after examination, your doctor may order an MRI to confirm the diagnosis or determine if the meniscal tear may be repaired.

In Part II we will discuss treatment options for this common knee condition….

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Tennis Elbow, Part II

Tuesday, May 19th, 2009

Almost 95 percent of people who suffer from tennis elbow will respond to conservative treatment.  This involves activities designed to decrease the inflammatory process as well as strengthen the muscles of the forearm.  Additionally, the use of a tennis elbow brace, a compression band placed around the upper forearm, may provide relief and reduce tension at the attatch,ent of the tendon.

The mainstays of the initial treatment plan are R.I.C.E., Rest the affected part, Ice massage over the elbow, Compression with an elastic bandage and Elevation of the elbow to decrease inflammation.  Additionally, non-steroidal anti-inflammatory agents such as Advil, Aleve, Nuprin or other prescription agents as prescribed by your doctor may be needed to blunt the inflammatory process.  In cases of persistent lateral epicondylitis, an injection of cortisone can be used to decrease pain and inflammation so that rehabilitative exercises are tolerable.

Exercises to strengthen the muscles of the forearm are the most important component of the rehabilitation of tennis elbow.  These can all be performed with nothing more exotic than a two-pound hammer.  There are seven exercises known as the “super 7″.  These involve two wrist stretches, four specific forearm exercises, and the seventh is a friction massage over the area of soreness.

If after several months of conservative therapy you have not had a significant reduction in pain and/or increase in strength, then surgery may be necessary to return you to sport or work.  The surgery is performed on an outpatient basis, after which you are kept in a splint for 7-10 days and then progressive stretching and strengthening is performed.

Prevention of tennis elbow is extremely important.  Warming up the forearm muscles and stretching should be part of every athlete’s regimen.  Strengthening of the forearm muscles also decreases the chances of injury.  Changes in equipment, such as a lighter racquet, can also reduce the likelihood of suffering this troublesome injury.

Tags: athletic, Dr Gary Levengood, elbow, elbow pain, exercise, forearm, orthopedic, orthopedic surgery, Physical Therapy, prevention, rehabilitation, sports medicine, sports medicine south, tennis elbow
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Tennis Elbow hits more than just tennis players, Part I

Sunday, May 17th, 2009

Have you ever experienced that sharp pain in your elbow after a long day of tennis?  If you have, you are among the 50 percent of tennis players who experience tennis elbow, or lateral epicondylitis.

This diagnosis is also common in other athletes such as baseball players, swimmers, and in manual laborers such as carpenters, plumbers, and anyone whose sport or job requires a repetitive arm motion.  This repetitive motion causes inflammation of the muscles and tendons on the outside of the elbow (lateral) which causes these tendons to become frayed and inflamed.

Tennis elbow is most commonly found in the 35-50 age group and occurs equally between men and women.  The most common cause is through overuse, although a direct blow to the elbow can also initiate these symptoms.  the pain in tennis elbow is exacerbated by continued use. or any activity in which the wrist is extended or bent backward.  An additional complaint in tennis elbow is weakness in the wrist extensors and decreased grip strength in the hand.  If ignored or left untreated, atrophy of the forearm muscles occurs.

Diagnosis of tennis elbow usually involves an exam of the elbow as well as x-rays of the elbow, which may show calcium deposits over the lateral epicondyle.  this calcification is the body’s attempt to heal this chronic inflammatory process.  This spur formation occurs in around 20 percent of sufferers.

In part II, we will review the treatment and prevention of Tennis Elbow.

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Ankle Sprains, Part III

Wednesday, April 15th, 2009

Prevention of ankle sprains
It is estimated that 30 to 40% of all ankle inversion sprains end in re-injury. To avoid being one of the 30 to 40% it is important not to stop the rehabilitation process but continue with it until full fitness is regained. It is a common complaint that once an athlete goes over on the ankle they become prone to doing the same thing again. If the original sprain is a bad one and joint laxity has resulted, then it may be for certain sports where fast changes of direction are required that strapping of the ankle or wearing a brace is necessary to prevent re-injury.

If the sprain does not result in joint laxity then a recurrence may be avoided by the following:
1. Re-establish proprioception. This involves lots of balancing exercises on one leg which is essential to avoid re-injury. If you start to turn the ankle over then you will find you automatically right it without even thinking about it. If the proprioception is damaged then you lose this ability.
2. You need to strengthen the ankle in order to provide a far more stable joint. Then, if the ankle does start to turn and the proprioceptors work as they should, the ankle muscles should contract quickly to hold the joint stable
3. For a severe sprain (one you can not put weight on), you may need a visit a physician to make sure you don’t have a fracture, ligament tendon damage or another serious ankle injury.

In general, you should avoid putting weight on the joint as long as you have swelling. When possible, you should keep your foot elevated. Within a couple of days, your pain should decrease enough to allow moderate weight bearing without pain. As you are able to tolerate more weight, you can begin a walking and gentle stretching program to increase your flexibility.

Proprioception exercises or balance exercise can help you recover more quickly and should actually be preformed as part of a prevention program. Poor balance is a good predictor of future ankle sprains. After an ankle injury, balance training is essential to recovery. In addition to our eyes and inner ears, there are special receptors in our joints (proprioceptors) that provide information about our position in space.

By balancing on one leg, you can reinforce and strengthen those receptors in the ankle. Balance on the affected leg and hold steady for 15 seconds. Continue to challenge your ankle by balancing with your eyes closed, or with your head turning from side to side. If you play soccer, balance on your sprained ankle and kick a soccer ball against a wall. If you play basketball, balance and shoot or practice bounce passes. Get creative with your exercise to match your sport.

Ankle sprains can be prevented by using appropriate equipment for your sport. However, sport-specific shoes and protective gear are just the start. To avoid ankle sprains, you need to strengthen your ankle joint and develop a highly refined balance system. Don’t forget to keep your first aid kit nearby.
• Range of Motion Exercises
Some simple exercises can help maintain ankle motion, and stretch the injured ligaments in the ankle joint.
• Achilles stretches
Achilles tendon stretching can easily be started soon after sustaining an ankle sprain. While seated or lying down, take a towel and loop it around your toes. Pull the ends of the towel, pulling your toes upwards, and feel the stretch in the back of the ankle. Perform this 3-4 times a day for several minutes.
• Alphabet writing
While seated or lying down, write the alphabet in the air with your toes. Make the letters as big as possible. Get creative by trying all uppercase, then lower case, then cursive, etc…
• Strength Exercises
The next step in recovery from ankle sprains is strengthening the muscles that surround the ankle joint. By strengthening these muscles, you can help support the ankle joint and help prevent further injury. Some exercises to perform after an ankle sprain include:
• Toe raises
Stand on a stair or ledge with your heel over the edge. Stand up on your tip toes, then in a controlled manner, let the heel rest down. Repeat 10-20 times (each foot), 4 times a day.
• Heel and Toe Walking
Walk on your toes for one minute, then on your heels for one minute. Alternate walking on your heel and toes, and work up in time to a total of 10 minutes, repeating 4 times each day.
• Activity-Specific Training
Activity specific exercises may include simply walking or jogging, or may be more intense for athletes who participate in basketball, soccer, or other sports. The key, no matter what level (recreational or competitive) athlete you may be, is to progress slowly. Begin at very low intensity, and very low duration of activity, and slowly work up–never suddenly increase either the intensity or duration of your activity.
Here is a sample progression for a soccer player
• Jogging
Begin at 50% intensity. Jog 100 yards, walk 100 yards. Repeat 4 times. Increase intensity and duration over 2-3 weeks
• Figure of Eights
Jog in a figure-of-8 pattern around cones. Begin with the cones near each other. Each day, spread out the cones and increase the speed.
• Box Runs
Make a box of cones. Jog forward the first side, side shuffle to the right, run backwards, then side shuffle to the left. Again, increase the size of the box and the speed of the running each day.

Once these activities can be done at full speed with no pain, patients can resume their sport. More sport specific exercises can be given to you by a coach or trainer if needed.

What if the pain continues?
The most common cause of persistent pain following an ankle sprain is known as incomplete rehabilitation. This means that patients either don’t complete the right type of rehabilitation, or they don’t progress properly (i.e. too fast or too slow). If you feel that your progress is not going along properly, make sure you seek advice such as speaking to your doctor or working with a physical therapist or athletic trainer. Most causes of chronic ankle pain are due to a lack of full rehabilitation and returning to play before all healing has occurred.

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Sports Medicine South Kicks Off Their New Blog

Monday, March 23rd, 2009

The staff of Sports Medicine South and I would like to extend our warmest welcome to you. Our desire is to present to you a comfortable and professional atmosphere for all your orthopaedic and sports medicine needs. Our mission remains to exceed the expectations of the patient by providing the highest quality of orthopaedic and sports medicine care available. Our core values of respect, professionalism, trust, caring for others, and education, drive us daily to meet that mission. Our goal is to not only care for the patient when the need arises but to become a stimulus that leads to decisions that promote a healthier and happier life. It is with that thought that we have started this blog. We honestly desire that Sports Medicine South becomes a place that leads you Beyond Better!

Our recent location and name change reflect our desire to remain Atlanta’s Orthopaedic & Sports Medicine Specialists. In order to continue to provide the best service available, we have moved into a state-of-the-art medical center located at 1900 Riverside Parkway, Lawrenceville, Georgia 30043. Our new center is in the heart of Gwinnett County, only minutes from the Gwinnett Medical Center, SR 316, and I-85! With improved parking, easy access, a large lobby, eight patient treatment rooms, cast and brace room, procedural room, digital imaging, on-site physical therapy and rehabilitation, and a patient education area, our new center is designed to exceed all patient expectations.

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